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Ellis, Cathryn, Laura Schummers, and Jean-Francois Rostoker. "Reducing Maternal Mortality in Uganda: Applying the “Three Delays” Framework." International Journal of Childbirth 1, no. 4 (2011): 218–26. http://dx.doi.org/10.1891/2156-5287.1.4.218.
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PURPOSE: This article examines maternal mortality in Uganda through the “Three Delays” framework. This framework asserts that maternal mortality in developing countries results from three delays to accessing appropriate health care: (a) the delay in making a timely decision to seek medical assistance, (b) the delay in reaching a health facility, and (c) the delay in provision of adequate care at a health facility.STUDY DESIGN: This study provides a review and synthesis of literature published about maternal mortality, the “Three Delays” concept, Uganda, and sub-Saharan Africa between 1995 and 2010.MAJOR FINDINGS: The “Three Delays” framework has relevance in the Ugandan context. This framework allows for an integrated and critical analysis of the interactions between cultural factors that contribute to the first delay and inadequate emergency obstetrical care related to the third delay.MAJOR CONCLUSION: In order to reduce maternal mortality in Uganda, governments and institutions must become responsive to the cultural and health needs of women and their families. Initiatives that increase educational and financial status of women, antenatal care, and rates of institutional care may reduce maternal mortality in the long term. Improvements to emergency obstetrical services are likely to have the most significant impact in the short term.
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Mukuru, Moses, Suzanne N. Kiwanuka, Linda Gibson, and Freddie Ssengooba. "Challenges in implementing emergency obstetric care (EmOC) policies: perspectives and behaviours of frontline health workers in Uganda." Health Policy and Planning 36, no. 3 (2021): 260–72. http://dx.doi.org/10.1093/heapol/czab001.
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Abstract Uganda is among the sub-Saharan African Countries which continue to experience high preventable maternal mortality due to obstetric emergencies. Several Emergency Obstetric Care (EmOC) policies rolled out have never achieved their intended targets to date. To explore why upstream policy expectations were not achieved at the frontline during the MDG period, we examined the implementation of EmOC policies in Uganda by; exploring the barriers frontline implementers of EmOC policies faced, their coping behaviours and the consequences for maternal health. We conducted a retrospective exploratory qualitative study between March and June 2019 in Luwero, Iganga and Masindi districts selected based on differences in maternal mortality. Data were collected using 8 in-depth interviews with doctors and 17 midwives who provided EmOC services in Uganda’s public health facilities during the MDG period. We reviewed two national maternal health policy documents and interviewed two Ministry of Health Officials on referral by participants. Data analysis was guided by the theory of Street-Level Bureaucracy (SLB). Implementation of EmOC was affected by the incompatibility of policies with implementation systems. Street-level bureaucrats were expected to offer to their continuously increasing clients, sometimes presenting late, ideal EmOC services using an incomplete and unreliable package of inputs, supplies, inadequate workforce size and skills mix. To continue performing their duties and prevent services from total collapse, frontline implementers’ coping behaviours oftentimes involved improvization leading to delivery of incomplete and inconsistent EmOC service packages. This resulted in unresponsive EmOC services with mothers receiving inadequate interventions sometimes after major delays across different levels of care. We suggest that SLB theory can be enriched by reflecting on the consequences of the coping behaviours of street-level bureaucrats. Future reforms should align policies to implementation contexts and resources for optimal results.
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Burt, Jessica Florence, Joseph Ouma, Lawrence Lubyayi, et al. "Indirect effects of COVID-19 on maternal, neonatal, child, sexual and reproductive health services in Kampala, Uganda." BMJ Global Health 6, no. 8 (2021): e006102. http://dx.doi.org/10.1136/bmjgh-2021-006102.
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BackgroundCOVID-19 impacted global maternal, neonatal and child health outcomes. We hypothesised that the early, strict lockdown that restricted individuals’ movements in Uganda limited access to services.MethodsAn observational study, using routinely collected data from Electronic Medical Records, was carried out, in Kawempe district, Kampala. An interrupted time series analysis assessed the impact on maternal, neonatal, child, sexual and reproductive health services from July 2019 to December 2020. Descriptive statistics summarised the main outcomes before (July 2019–March 2020), during (April 2020–June 2020) and after the national lockdown (July 2020–December 2020).ResultsBetween 1 July 2019 and 31 December 2020, there were 14 401 antenatal clinic, 33 499 deliveries, 111 658 childhood service and 57 174 sexual health attendances. All antenatal and vaccination services ceased in lockdown for 4 weeks.During the 3-month lockdown, the number of antenatal attendances significantly decreased and remain below pre-COVID levels (370 fewer/month). Attendances for prevention of mother-to-child transmission of HIV dropped then stabilised. Increases during lockdown and immediately postlockdown included the number of women treated for high blood pressure, eclampsia and pre-eclampsia (218 more/month), adverse pregnancy outcomes (stillbirths, low-birth-weight and premature infant births), the rate of neonatal unit admissions, neonatal deaths and abortions. Maternal mortality remained stable. Immunisation clinic attendance declined while neonatal death rate rose (from 39 to 49/1000 livebirths). The number of children treated for pneumonia, diarrhoea and malaria decreased during lockdown.ConclusionThe Ugandan response to COVID-19 negatively impacted maternal, child and neonatal health, with an increase seen in pregnancy complications and fetal and infant outcomes, likely due to delayed care-seeking behaviour. Decreased vaccination clinic attendance leaves a cohort of infants unprotected, affecting all vaccine-preventable diseases. Future pandemic responses must consider impacts of movement restrictions and access to preventative services to protect maternal and child health.
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Atuhaire, Ruth, Robert Wamala, Leonard K. Atuhaire, and Elizabeth Nansubuga. "Regional differentials in early antenatal care, health facility delivery and early postnatal care among women in Uganda." Journal of Economics and Behavioral Studies 13, no. 4(J) (2021): 17–30. http://dx.doi.org/10.22610/jebs.v13i4(j).3174.
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This study aimed at examining regional differentials in maternal healthcare services in Uganda. Using a sample of 1,521 women of reproductive ages (15-49) from Eastern and Western sub-regions of Uganda, and non-linear Oaxaca’ Blinder Multivariate Decomposition method, we assessed differentials in utilization of early antenatal care, health facility delivery and early postnatal care services among the women, henceforth, establishing main predictors of regional inequalities that will enable policymakers to make better evenly interventions and focused decisions. The study reveals that differentials in the utilization of maternal healthcare services are not only hindered by social and economic barriers, but also widespread disparities in the utilization of existing services. Significant differentials were attributed to both variation in women’s characteristics and effects of coefficients. Findings showed that the gap in early antenatal care would reduce on average by 31.6% and 34.7% of differences in availability of community health workers and media exposure respectively, were to disappear. Furthermore, the gap would increase on average by 68.8% and 12.6% in absence of the variation in effects of maternal education, and wealth respectively. The gap in health facility delivery would reduce on average by 24.6% and 37.2% of differences in community health worker availability and media exposure were to disappear respectively and increase on average by 54.9% in the absence of variations in effects of maternal education. The gap in EPNC would reduce on average by 18.5% and 17.17% of differences in maternal education and community health worker availability were to disappear respectively and increase on average by 52.8% and 8.4% in the absence of the variation in effects of maternal education and wealth respectively. Progress towards equitable maternal health care should focus more on strategies that guarantee even distribution of community health workers, broad dissemination of maternal healthcare information and girl child education completion in Uganda.
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Nabudere, Harriet, Delius Asiimwe, and Rhona Mijumbi. "Task shifting in maternal and child health care: An evidence brief for Uganda." International Journal of Technology Assessment in Health Care 27, no. 2 (2011): 173–79. http://dx.doi.org/10.1017/s0266462311000055.
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The Problem: There is a shortage and maldistribution of medically trained health professionals to deliver cost-effective maternal and child health (MCH) services. Hence, cost-effective MCH services are not available to over half the population of Uganda and progress toward the Millennium Development Goals for MCH is slow. Optimizing the roles of less specialized health workers (“task shifting”) is one strategy to address the shortage and maldistribution of more specialized health professionals.Policy Options: (i) Lay health workers (community health workers) may reduce morbidity and mortality in children under five and neonates; and training for traditional birth attendants may improve perinatal outcomes and appropriate referrals. (ii) Nursing assistants in facilities might increase the time available from nurses, midwives, and doctors to provide care that requires more training. (iii) Nurses and midwives to deliver cost-effective MCH interventions in areas where there is a shortage of doctors. (iv) Drug dispensers to promote and deliver cost-effective MCH interventions and improve the quality of the services they provide. The costs and cost-effectiveness of all four options are uncertain. Given the limitations of the currently available evidence, rigorous evaluation and monitoring of resource use and activities is warranted for all four options.Implementation Strategies: A clear policy on optimizing health worker roles. Community mobilization and reduction of out-of-pocket costs to improve mothers’ knowledge and care-seeking behaviors, continuing education, and incentives to ensure health workers are competent and motivated, and community referral and transport schemes for MCH care are needed.
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Dey, Teesta, Sam Ononge, Andrew Weeks, and Lenka Benova. "Immediate postnatal care following childbirth in Ugandan health facilities: an analysis of Demographic and Health Surveys between 2001 and 2016." BMJ Global Health 6, no. 4 (2021): e004230. http://dx.doi.org/10.1136/bmjgh-2020-004230.
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IntroductionProgress in reducing maternal and neonatal mortality, particularly in sub-Saharan Africa, is insufficient to achieve the Sustainable Developmental Goals by 2030. The first 24 hours following childbirth (immediate postnatal period), where the majority of morbidity and mortality occurs, is critical for mothers and babies. In Uganda,<50% of women reported receiving such care. This paper describes the coverage, changes over time and determinants of immediate postnatal care in Uganda after facility births between 2001 and 2016.MethodsWe analysed the 2006, 2011 and 2016 Ugandan Demographic and Health Surveys, including women 15–49 years with most recent live birth in a healthcare facility during the survey 5-year recall period. Immediate postnatal care coverage and changes over time were presented descriptively. Multivariable logistic regression was used to examine determinants of immediate postnatal care.ResultsData from 12 872 mothers were analysed. Between 2006 and 2016, births in healthcare facilities increased from 44.6% (95% CI: 41.9% to 47.3%) to 75.2% (95% CI: 73.4% to 77.0%) and coverage of immediate maternal postnatal care from 35.7% (95% CI 33.4% to 38.1%) to 65.0% (95% CI: 63.2% to 66.7%). The majority of first checks occurred between 1 and 4 hours post partum; the median time reduced from 4 hours to 1 hour. The most important factor associated with receipt of immediate postnatal care was women having a caesarean section birth adjusted OR (aOR) 2.93 (95% CI: 2.28 to 3.75). Other significant factors included exposure to mass media aOR 1.38 (95% CI: 1.15 to 1.65), baby being weighed at birth aOR 1.84 (95% CI: 1.58 to 2.14) and receipt of antenatal care with 4+Antenatal visits aOR 2.34 (95% CI: 1.50 to 3.64).ConclusionIn Uganda, a large gap in coverage remains and universal immediate postnatal care has not materialised through increasing facility-based births or longer length of stay. To ensure universal coverage of high-quality care during this critical time, we recommend that maternal and newborn services should be integrated and actively involve mothers and their partners.
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Pariyo, George W., Chrispus Mayora, Olico Okui, et al. "Exploring new health markets: experiences from informal providers of transport for maternal health services in Eastern Uganda." BMC International Health and Human Rights 11, Suppl 1 (2011): S10. http://dx.doi.org/10.1186/1472-698x-11-s1-s10.
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Nathan, Isabirye, Agnes Nyabigambo, Agnes Kayego, Peter Waiswa, Kele Moley, and Salimah Walani. "Readiness for implementation of preconception care in Uganda; a review on the current policy, health system barriers, opportunities and way forward." International Journal of Pregnancy & Child Birth 7, no. 3 (2021): 68–72. http://dx.doi.org/10.15406/ipcb.2021.07.00231.
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Background: Uganda like other low-income countries, preconception health has received no attention. Communications in this article are derived from preliminary findings of an ongoing preconception baseline pilot in Luuka-a rural eastern district of Uganda. This is a phased study, including a desk review of literature and a short baseline pilot. Methods: The review followed the methodology of systematic reviews. Key electronic databases were searched including PUBMED/MEDLINE and google scholar. Also, reports from ministries/academic institution libraries and views from experts were done. English articles published post 2000, covering preconception care, barriers, facilitators and policies were included in the review. Out of 110 shortlisted abstracts, 28 were included. Studies were extracted onto structured formats and analysed using the narrative synthesis approach. Results: There exist unstructured preconception health and service guidelines in Uganda. Barriers to preconception service integration into the district’s health system include; lack of a clear policy, careworn health system and care seeker related factors. Opportunities for preconception service integration include; poor maternal and neonatal health indicators, positive change in health seeking behaviour, existence of a gap in the care continuum, functional VHT system to link the community to services, anticipated roll out of key family care practises by Ministry of Health Uganda, and improved access to radio & mobile phones. Conclusion: Formulation of clear preconception guidelines, testing health system integration approaches, stakeholders’ engagement, awareness creation and strengthening the supply side is recommended as a way forward
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Nabukeera, Madinah. "The impact of the Country’s health services’ expenditure on the success of MDGs, Goal 4/SDG 3: Reduction of child mortality in Uganda (2000-2016)." Archives of Business Research 8, no. 8 (2020): 69–82. http://dx.doi.org/10.14738/abr.88.8858.
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Safeguarding access to health services is a serious challenge for poor countries if the Sustainable Development Goals are to (SDGs) are to be achieved. This paper scrutinizes the case of Uganda, a country which is trying to improve its health sector amid a lot of challenges between 2000-2016 to assess how the country has performed in the reduction of child mortality given its expenditure. This study involved analyzing the available data drawn from various sources i.e., time series data on public health expenditure was obtained from Ministry of Health reports and the budget and Ministerial Policy Statements for the period 2000-2016. This data was further demarcated into parameters such as per capita government spending on health in Uganda shillings, health spending as a proportion of Gross Democratic Product (GDP) and private health spending as a proportion of total health spending. Findings revealed that non-significant negative effect of GDP per capita growth on infant mortality rate from 2000 to 2016, a negative effect of GDP per capita on under-five mortality in Uganda from 2000 to 2016, albeit the effect is non-significant (P>0.05), decline in Maternal Mortality Rate (MMR) from 527 death per 100,000 live birth in 1995 to 336 death per 100,000 live birth in 2016, and there is a negative but insignificant effect of health sector budget allocation on the MMR in Uganda since the P-value (0.199). Maternal mortality fell significantly in Uganda due to some interventions in the health sector. The decline is likely to have been cause due to supply and demand situations. There is need to improve funding in the health sector in order to improve quality health services through better coordination, health management, transportation, access, infrastructure at the district level.
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Andriano, Liliana, and Christiaan W. S. Monden. "The Causal Effect of Maternal Education on Child Mortality: Evidence From a Quasi-Experiment in Malawi and Uganda." Demography 56, no. 5 (2019): 1765–90. http://dx.doi.org/10.1007/s13524-019-00812-3.
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Abstract Since the 1980s, the demographic literature has suggested that maternal schooling plays a key role in determining children’s chances of survival in low- and middle-income countries; however, few studies have successfully identified a causal relationship between maternal education and under-5 mortality. To identify such a causal effect, we exploited exogenous variation in maternal education induced by schooling reforms introducing universal primary education in the second half of the 1990s in Malawi and Uganda. Using a two-stage residual inclusion approach and combining individual-level data from Demographic and Health Surveys with district-level data on the intensity of the reform, we tested whether increased maternal schooling reduced children’s probability of dying before age 5. In Malawi, for each additional year of maternal education, children have a 10 % lower probability of dying; in Uganda, the odds of dying for children of women with one additional year of education are 16.6 % lower. We also explored which pathways might explain this effect of maternal education. The estimates suggest that financial barriers to medical care, attitudes toward modern health services, and rejection of domestic violence may play a role. Moreover, being more educated seems to confer enhanced proximity to a health facility and knowledge about the transmission of AIDS in Malawi, and wealth and improved personal illness control in Uganda.
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Kisakye, Angela N., Rornald Muhumuza Kananura, Elizabeth Ekirapa-Kiracho, et al. "Effect of support supervision on maternal and newborn health services and practices in Rural Eastern Uganda." Global Health Action 10, sup4 (2017): 1345496. http://dx.doi.org/10.1080/16549716.2017.1345496.
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Kalule-Sabiti, Ishmael, Acheampong Yaw Amoateng, and Mirriam Ngake. "The Effect of Socio-demographic Factors on the Utilization of Maternal Health Care Services in Uganda." African Population Studies 28, no. 1 (2014): 515. http://dx.doi.org/10.11564/28-1-504.
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Bergmann, Julie N., Rhoda K. Wanyenze, Fred Makumbi, Rose Naigino, Susan M. Kiene, and Jamila K. Stockman. "Maternal Influences on Access to and Use of Infant ARVs and HIV Health Services in Uganda." AIDS and Behavior 21, no. 9 (2016): 2693–702. http://dx.doi.org/10.1007/s10461-016-1528-1.
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Javadi, Dena, John Ssempebwa, John Bosco Isunju, et al. "Implementation research on sustainable electrification of rural primary care facilities in Ghana and Uganda." Health Policy and Planning 35, Supplement_2 (2020): ii124—ii136. http://dx.doi.org/10.1093/heapol/czaa077.
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Abstract Access to energy is essential for resilient health systems; however, strengthening energy infrastructure in rural health facilities remains a challenge. In 2015–19, ‘Powering Healthcare’ deployed solar energy solutions to off-grid rural health facilities in Ghana and Uganda to improve the availability of maternal and child health services. To explore the links between health facility electrification and service availability and use, the World Health Organization (WHO), in partnership with Dodowa Health Research Centre and Makerere University School of Public Health, carried out an implementation research study. The objectives of this study were to (1) capture changes in service availability and readiness, (2) describe changes in community satisfaction and use and (3) examine the implementation factors of sustainable electrification that affect these changes. Data were collected through interviews with over 100 key informants, focus group discussions with over 800 community members and health facility assessment checklist adapted from the WHO’s Service Availability and Readiness Assessment tool. Implementation factors were organized using Normalization Process Theory constructs. The study found that access to energy is associated with increased availability of health services, access to communication technologies, appropriate storage of vaccines and medicines, enhanced health worker motivation and increased community satisfaction. Implementation factors associated with improved outcomes include stakeholder engagement activities to promote internalization, provision of materials and information to encourage participation, and establishment of relationships to support integration. Barriers to achieving outcomes are primarily health systems challenges—such as drug stockouts, lack of transportation and poor amenities—that continue to affect service availability, readiness and use, even where access to energy is available. However, through appropriate implementation and integration of sustainable electrification, strengthened energy infrastructure can be leveraged to catalyze investment in other components of functioning health systems. Improving access to energy in health facilities is, therefore, necessary but not sufficient for strengthening health systems.
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Franco, Gabala, Juliet Ndibaisa, and Namumbya Slivia. "Women Mobile Lifeline Channel Is a Key Stimulant of MCH Services Use in Resource Constrained Settings: A Success Story of Women Health Channel Uganda." Iproceedings 5, no. 1 (2019): e15239. http://dx.doi.org/10.2196/15239.
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Background Uganda has made progress in recent decades; however, the country still ranks among the top 10 countries in the world with high maternal, newborn, and child mortality rates. 336 women in every 100000 live births die due to preventable pregnancy related causes (under-five mortality rate 64/1000 live births; infant mortality rate 43/1000 live births; and neonatal mortality rate 27/1000 live births). Despite the growing global focus on reaching the last mile that necessitates the development of mHealth tools that best reach, empower, and mobilize the last mile women to seek and utilize critical and life-saving health care services as a vehicle for accelerating reduction of maternal and child deaths, mHealth tools in Uganda continue to limit focus on reporting and trucking of health indicators. Objective MIRA Channel is a single-window app with multiple channels on prenatal care, child immunization, newborn care, and family planning with the objective to improve maternal and child health outcomes in rural and resource-constrained settings. The app delivers information to women through interactive edutainment tools that builds on their knowledge, thus creating awareness on critical health issues and preempt timely use of MCH services. Methods Women Health Channel Uganda piloted the Women Mobile Lifeline Channel app in 15 public health facilities in Jinja district, Uganda, and particularly targeted pregnant women. A systematic review of records, particularly the health facility ANC register, was done to estimate the facility clientele size. Purposive random sampling was used to arrive at the survey sample. Two contact midwives and 5 VHTs were selected, trained, and given a connected mobile device at each of the implementing health facilities. Recruitment of women on the platform was done by VHTs using connected phones at community level, and 3489 pregnant women were studied for 16 months. Data was collected at baseline and at end line. Results Both at baseline and at end line, information on knowledge as well as usage of key MCH services was collected. All women had heard of ANC and the recommended place of delivery; however, only 59% at baseline had knowledge of the exact recommended number of ANC visits as opposed to 94% at end line. At baseline, 36% of women reported to have attended ANC 4 or more times at the most recent pregnancy as opposed to 82% at end line, while 63% of women at baseline reported to have given birth in a health facility for the previous pregnancy as opposed to 94% at end line. Sven neonatal deaths were reported in the cohort at baseline as opposed to 0 maternal deaths and 1 neonatal death at end line. Conclusions The pilot showed that one critical determinant of use of MCH services is the overall client knowledge and the perceived available support mechanism in the face of challenges. mHealth tools ought to expand focus to include stimulation of two-way mobile-based interactions that reinforce behavior change and preempt use as such. The Women Mobile Lifeline Channel that Women Health Channel is implementing offers lenses for Uganda and other countries to walk towards meaningful ICT integration in health.
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Okungu, Vincent, Marshal Mweu, and Janine Mans. "SUSTAINABILITY, EQUITY AND EFFECTIVENESS IN PUBLIC FINANCING FOR HEALTH IN UGANDA: AN ASSESSMENT OF MATERNAL AND CHILD HEALTH SERVICES." International Journal of Health Services Research and Policy 4, no. 3 (2019): 233–46. http://dx.doi.org/10.23884/ijhsrp.2019.4.3.08.
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Orach, Christopher Garimoi. "Maternal Mortality Estimated Using the Sisterhood Method in Gulu District, Uganda." Tropical Doctor 30, no. 2 (2000): 72–74. http://dx.doi.org/10.1177/004947550003000205.
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A community-based retrospective maternal mortality study using the Sisterhood method was conducted in Gulu district between February and March 1996. The objectives were to estimate the magnitude of and identify factors associated with maternal mortality in the district. Atotal of 5522 adult respondents, randomly selected from 27 parishes, of the five counties in the district were interviewed. Between 1960–1996 324 maternal deaths occurred in the sisterhood sample. The maternal mortality rate (MMR) was estimated to be 662 per 100 000 deliveries [95% confidence interval (CI) 421–839 per 100 deliveries]. The leading causes of maternal death were: haemorrhage 45.1%; obstructed labour 26.2%; puerperal sepsis 9.6%; anaemia 2.2%; AIDS 2.2%; and gunshot wounds (GSW) 1.0%. Factors associated with maternal mortality included: age − 31.8% of the mothers who died were below 20 years; education − 57.1% had no formal education; 65% of the mothers had delivered at home, 50.6% had been attended to by untrained traditional birth attendants (TBAs), while 37.8% were attended to by relatives. The MMR was found to be 1.3 times higher than the estimated national MMR of 500 per 100 000 deliveries. Most maternal deaths (80.9%) were due to preventable causes, being related to low socioeconomic status and low-level education of women in the district. The intractable civil war in the district was a major underlying and contributory factor to the high maternal mortality in the area. A multifaceted approach to reduce maternal mortality in the district should target improving the socioeconomic conditions in the district with special emphasis on encouraging and supporting female education. Intensive education on maternal healthcare in antenatal clinics be conducted targeting husbands/spouses and relatives who care for the prenatal/pregnant and postnatal mothers. There is need for more trained TBAs per village who should be given effective support supervision. Ambulance transport services, motor and bicycle be made available at the district and community levels. At a national level the security situation should be improved in the district.
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Mutebi, Aloysius, Rornald Muhumuza Kananura, Elizabeth Ekirapa-Kiracho, et al. "Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services." Global Health Action 10, sup4 (2017): 1347363. http://dx.doi.org/10.1080/16549716.2017.1347363.
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Massavon, William, Calistus Wilunda, Maria Nannini, et al. "Community perceptions on demand-side incentives to promote institutional delivery in Oyam district, Uganda: a qualitative study." BMJ Open 9, no. 9 (2019): e026851. http://dx.doi.org/10.1136/bmjopen-2018-026851.
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ObjectiveTo examine the perceptions of community members and other stakeholders on the use of baby kits and transport vouchers to improve the utilisation of childbirth services.DesignA qualitative study.SettingOyam district, Uganda.ParticipantsWe conducted 10 focus group discussions with 59 women and 55 men, and 18 key informant interviews with local leaders, village health team members, health facility staff and district health management team members. We analysed the data using qualitative content analysis.ResultsFive broad themes emerged: (1) context, (2) community support for the interventions, (3) health-seeking behaviours postintervention, (4) undesirable effects of the interventions and (5) implementation issues and lessons learnt. Context regarded perceived long distances to health facilities and high transport costs. Regarding community support for the interventions, the schemes were perceived to be acceptable and helpful particularly to the most vulnerable. Transport vouchers were preferred over baby kits, although both interventions were perceived to be necessary. Health-seeking behaviours entailed perceived increased utilisation of maternal health services and ‘bypassing’, promotion of collaboration between traditional birth attendants and formal health workers, stimulation of men’s involvement in maternal health, and increased community awareness of maternal health. Undesirable effects of the interventions included increased workload for health workers, sustainability concerns and perceived encouragement to reproduce and dependency. Implementation issues included information gaps leading to confusion, mistrust and discontent, transport voucher scheme design; implementation; and payment problems, poor attitude of some health workers and poor quality of care, insecurity, and a shortage of baby kits. Community involvement was key to solving the challenges.ConclusionsThe study provides further insights into the implementation of incentive schemes to improve maternal health services utilisation. The findings are relevant for planning and implementing similar schemes in low-income countries.
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Isaac Ocheng V. O., Isaac, Eddy Ika, and Kizito Omona [PhD]. "Factors Influencing Utilization of Maternal Health Services by Adolescent Young Mothers Aged 15-19 Years in Kiryandongo General Hospital." International Journal of Medicine 9, no. 1 (2021): 31. http://dx.doi.org/10.14419/ijm.v9i1.31389.
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Background: In Uganda, 25 % of adolescents age 15-19 have already begun childbearing, 19 % have already given birth and another 5 % pregnant with their first child. Utilization of maternal health services is, therefore, an effective approach to reducing the risk of maternal morbidity and mortality. Low utilization of Maternal Health Services (MHS) has been registered in many parts of Uganda.Objective: To identify the key factors that influenced the utilization of MHS by adolescent young mothers aged 15-19years in Kiryandongo general HospitalMethods: A Cross Sectional analytical design, both quantitative and qualitative was used. A total of 98 adolescent young mothers were randomly selected. Data was collected using semi-structure questionnaires and analyzed using SPSS version 19.Results: Level of utilization of MHS was 44.9%. The socio-demographic (personal) factors that significantly influenced MHS utilization were; maternal age (COR= 0.29; 95% CI: 0.13-0.67, p = 0.003), husband’s education level (COR= 0.19; 95% CI: 0.08-0.47, p =0.000) and husband’s monthly income (COR= 0.35; 95% CI: 0.15-0.80, p = 0.012). Health System factors that influenced MHS utilization included; Time for travelling to reach health facility (COR=2.39; 95% CI: 1.03-5.52, p = 0.040) and Cost of the health services (COR= 2.68; 95% CI: 1.17-6.15, p =0.019).Conclusion: Strategies in addressing decision-making norms, engaging in massive community dialogue and designing appropriate communication strategies may help improve MHS utilization.
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Beyeza-Kashesya, Jolly, Frank Kaharuza, and Daniel Murokora. "The advantage of professional organizations as advocates for improved funding of maternal and child health services in Uganda." International Journal of Gynecology & Obstetrics 127 (August 1, 2014): S52—S55. http://dx.doi.org/10.1016/j.ijgo.2014.07.013.
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Egami, Hiroyuki, and Tomoya Matsumoto. "Mobile Money Use and Healthcare Utilization: Evidence from Rural Uganda." Sustainability 12, no. 9 (2020): 3741. http://dx.doi.org/10.3390/su12093741.
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Lack of cash on hand is a significant obstacle in accessing healthcare services in developing countries. Many expectant mothers in the least developed countries do not receive sufficient care during pregnancy due to financial constraints. If such hurdles in accessing healthcare can be overcome, it will contribute to reduction in maternal and newborn mortality, which is a key target of Sustainable Development Goal 3. This study reports the first assessment of the impact of mobile money services on maternal care utilization. We hypothesize that mobile money adoption would motivate rural Ugandan women to receive antenatal care and to deliver their children at health facilities or with skilled birth attendants. By receiving remittances utilizing mobile money, poor rural households may obtain more cash in hand, which might change women’s health-seeking behavior. We apply community- and mother-fixed effects models with heterogeneity analysis to longitudinal panel data (the RePEAT [Research on Poverty, Environment, and Agricultural Technology] survey) of three waves (2009, 2012, and 2015). The analysis uses pregnancy reports of 2007–2015 from 586 rural Ugandan households. We find suggestive evidence that mobile money adoption positively affects the take-up of antenatal care. Heterogeneity analysis indicates that mobile money brings a larger benefit to geographically challenged households by easing their liquidity constraint as they face higher cost of traveling to distant health facilities. The models failed to reject the null hypothesis of no mobile money effect on the delivery-related outcome variables. This study suggests that promoting financial inclusion by means of mobile money motivates women in rural and remote areas to make antenatal care visits while the evidence of such effect is not found for take-up of facility delivery or delivery with skilled birth attendants.
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Nalukwago, Judith, Bolanle Olapeju, Anna Passaniti, et al. "Effects of Coronavirus Pandemic on Young Adults’ Ability to Access Health Services and Practice Recommended Preventive Measures." Global Journal of Health Science 13, no. 11 (2021): 14. http://dx.doi.org/10.5539/gjhs.v13n11p14.
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Given the limited attention to young adults as key contributors to the spread of COVID-19 in Uganda, this study examines the effects of the outbreak on the ability of young adults aged 18-29 to access health services and practice preventive measures. A national population-based mobile phone survey was conducted in December 2020. Multivariable regression analyses were used to explore the effect of the COVID-19 pandemic on access to health care services. Control variables included region, education level, parity, and source of health information. The majority (98%) perceived COVID-19 as a serious threat to Ugandans. Although the majority reported handwashing (97%) and masking (92%), fewer respondents avoided shaking hands (39%), ensured physical distancing (57%), avoided groups of more than four people (43%), stayed home most days (30%), avoided touching eyes, nose, and mouth (14%), and practiced sneezing/coughing into their elbow (7%). Participants noted that the COVID-19 pandemic affected their ability to access family planning (40%), HIV (49%), maternal health (55%), child health (56%), and malaria (63%) services. The perceived effect of the COVID-19 pandemic on services was higher for those in the Northern region (OR= 2.00, 95% CI 1.00-4.02), those with higher education OR= 2.26, 95% CI 1.28-3.99), those with five plus children (OR= 2.05, 95% CI 0.92-4.56), and those who trust radio for COVID-19 information (OR= 1.65, 95% CI 1.01-2.67). The findings show the pragmatic importance of understanding the dynamic characteristics and behavioral patterns of young adults in the context of COVID-19 to inform targeted programming.
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Musiimenta, Angella, Wilson Tumuhimbise, Niels Pinkwart, Jane Katusiime, Godfrey Mugyenyi, and Esther C. Atukunda. "A mobile phone-based multimedia intervention to support maternal health is acceptable and feasible among illiterate pregnant women in Uganda: Qualitative findings from a pilot randomized controlled trial." DIGITAL HEALTH 7 (January 2021): 205520762098629. http://dx.doi.org/10.1177/2055207620986296.
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Background Uganda’s maternal mortality rate remains unacceptably high. Mobile phones can potentially provide affordable means of accessing maternal health services even among the otherwise hard-to-reach populations. Evidence about the acceptability and feasibility of mobile phone-based interventions targeting illiterate women, however, is limited. Objective To assess the acceptability and feasibility of a mobile phone-based multimedia application (MatHealth app) to support maternal health amongst illiterate pregnant women in rural southwestern Uganda. Methods 80 pregnant women initiating antenatal care from Mbarara regional referral hospital were enrolled in a pilot randomized controlled trial and followed until six weeks after delivery. The 40 women in the intervention group received a MatHealth app composed of educational videos/audios, clinic appointment reminders, and the calling function. Qualitative interviews on acceptability of this technology were carried out with 30 of the intervention participants. An inductive, content analytic approach was used to analyze qualitative data. Quantitative feasibility data were recorded and summarized descriptively. Results Participants reported that the intervention is acceptable as it enabled them adopt good maternal health practices, enhanced social support from spouses, provided clinic appointment reminders, and facilitated communication with healthcare providers. Challenges included: phone sharing (74%), accidental deletion of the application 15 (43%), lack of electricity 15 (43%), and inability to set up a reminder function 20 (57%). Conclusion The MatHealth app is an acceptable and feasible intervention among illiterate women, in a resource limited setting. Future efforts should focus on optimized application design, spouse orientation, and incorporating economic support to overcome the challenges we encountered.
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Nankumbi, Joyce, Tom Dennis Ngabirano, and Gorrette Nalwadda. "Maternal Nutrition Education Provided by Midwives: A Qualitative Study in an Antenatal Clinic, Uganda." Journal of Nutrition and Metabolism 2018 (October 25, 2018): 1–7. http://dx.doi.org/10.1155/2018/3987396.
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Maternalnutrition during pregnancy affects the health of the mother and baby. The objective of this paper is to describe the maternal nutrition education offered by midwives to women attending an antenatal clinic. The study also examined the resources, support, and the needs of the midwives in offering the nutrition education. Six in-depth interviews with the midwives, six direct structured observations of the group education, and 12 one-on-one interactions of midwife and pregnant women observations were completed. The interviews and field observation notes were typed and analyzed using the latent content analysis. The emerging themes were the maternal nutrition education and the education needs of the midwives. The content and presentation of maternal nutrition were inadequate in scope and depth. The maternal nutrition education was offered to only pregnant women attending the first antenatal care visit. The routine antenatal education session lasted 45 minutes to 1 hour, covering a variety of topics, but the nutritional component was allotted minimal time (5–15 minutes). The organization, mode of delivery, guidelines, resources, and service environment were extremely deficient. The relevance of appropriate weight gain during pregnancy, guidelines for healthy habits, avoidance of substance abuse, and nutrition precautions in special circumstances was missing in the nutrition presentation. Information, maternal nutrition education resources, infrastructure, and health system gaps were identified. There was an inefficient nutrition education offered to the pregnant women attending the antenatal clinic. As means of promoting effective nutrition education, appropriate in-service training, mentorship, and support for the midwives are needed, as well as infrastructural and resource provision.
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Salgado, Mariana, Melanie Wendland, Damaris Rodriguez, et al. "A service concept and tools to improve maternal and newborn health in Nigeria and Uganda." International Journal of Gynecology & Obstetrics 139 (December 2017): 67–73. http://dx.doi.org/10.1002/ijgo.12382.
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Mayora, Chrispus, Elizabeth Ekirapa-Kiracho, David Bishai, David H. Peters, Olico Okui, and Sebastian Baine. "Incremental cost of increasing access to maternal health care services: perspectives from a demand and supply side intervention in Eastern Uganda." Cost Effectiveness and Resource Allocation 12, no. 1 (2014): 14. http://dx.doi.org/10.1186/1478-7547-12-14.
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Mwase, I., M. Hutchins, A. Cameron, et al. "Experiences of using the toll-free telephone line to access maternal and newborn health services in central Uganda: a qualitative study." Public Health 179 (February 2020): 1–8. http://dx.doi.org/10.1016/j.puhe.2019.09.015.
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Izudi, Jonathan, Agnes Akot, Grace Paul Kisitu, Pauline Amuge, and Adeodata Kekitiinwa. "Quality Improvement Interventions for Early HIV Infant Diagnosis in Northeastern Uganda." BioMed Research International 2016 (2016): 1–8. http://dx.doi.org/10.1155/2016/5625364.
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Introduction. Early infant diagnosis (EID) of human immunodeficiency virus (HIV) ensures prompt treatment and infant survival. In Kaabong Hospital, 20% of HIV exposed infants (HEIs) had access to HIV diagnosis by eight weeks. We aimed to improve EID of HIV by deoxyribonucleic acid-polymerase chain reaction (DNA-PCR) testing by eight weeks from 20 to 100% between June 2014 and November 2015. Method. In this quality improvement (QI) project, EID data was reviewed, gaps prioritized using theme matrix selection, root causes analyzed using fishbone tool, and improvement changes were selected using counter measures matrix but implemented using Plan-Do-Study-Act cycle. Root causes of low first DNA-PCR testing included maternal EID ignorance, absent lost mother-baby pairs (LMBP) tracking system, and no EID performance reviews. Health education, Continuous Medical Education (CMEs), and integration of laboratory and EID services were initial improvement changes used. Results. DNA-PCR testing increased from 20 to 100% between June 2014 and July 2015 and was sustained at 100% until February 2016. Two declines, 67% in September 2014 and 75% in June 2015, due to LMBP were addressed using expert clients and peer mothers, respectively. Conclusion. Formation of WIT, laboratory service integration at MBCP, and task shifting along EID cascade improved EID outcomes at 6 weeks.
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Babughirana, Geoffrey, Sanne Gerards, Alex Mokori, et al. "Effects of Implementing the Timed and Targeted Counselling Model on Pregnancy Outcomes and Newborn Survival in Rural Uganda: Protocol for a Quasi-Experimental Study." Methods and Protocols 3, no. 4 (2020): 73. http://dx.doi.org/10.3390/mps3040073.
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Background: Although mortality rates have declined in Uganda over the last decade, maternal mortality is still high at 336 deaths per 100,000 live births, as is infant mortality at 43 deaths per 1000 live births. One in every 19 babies born in Uganda does not live to celebrate their first birthday. Many of these deaths occur within the first 28 days of life, forming the single largest category of death. Promising effects for preventing death are expected from timed and targeted counselling (ttC), an intervention package of key messages and actions that address integrated health and nutrition needs of the mothers and children, barriers and negotiation agreement, to cause sustainable behavioural change at specific timelines in the first 1000 days. Methods: The study has a quasi-experimental design in order to evaluate the implementation and effectiveness of the ttC intervention. Participants are pregnant women who have been registered by village health team (VHT) members and who live in Hoima (intervention region) or Masindi (control region) districts, who will be monitored throughout their pregnancy up to at least six weeks after delivery. A multi-stage sampling technique will be employed to select participants, the study sites being purposively chosen. Sample size is determined using the pregnancy rate from the population estimates, resulting in a total required sample of 1218 (609 each in the intervention and control group). Study instruments that will be used include the Ugandan VHT household register (in which all mothers to be studied will be registered), the ttC register (an additional tool for the study area), and a study questionnaire, to collect data at outcome level. Univariate, bivariate and multivariate analyses will be performed using SPSS to evaluate intervention effects on outcomes (e.g., relationship between pregnancy outcomes and antenatal attendance). In addition, quantitative findings will be triangulated with qualitative data, and collected through interviews and focus group discussions with participants and implementers. Discussion: The proposed study will examine the effectiveness of implementing ttC to improve maternal and child outcomes in Uganda. If ttC is effective, broader implementation of appropriate antenatal services can be advised as essential newborn care improvements. Trial registration: PACTR, PACTR202002812123868. Registered on 25 February 2020.
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Kiondo, Paul, Annettee Nakimuli, Samuel Ononge, Julius Namasake Wandabwa, and Milton Wamboko Musaba. "Predictors of Intrapartum Stillbirths among Women Delivering at Mulago Hospital, Kampala, Uganda." International Journal of Maternal and Child Health and AIDS (IJMA) 10, no. 2 (2021): 156–65. http://dx.doi.org/10.21106/ijma.409.
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Background: Over the last decade, Uganda has registered a significant improvement in the utilization of maternity care services. Unfortunately, this has not resulted in a significant and commensurate improvement in the maternal and child health (MCH) indicators. More than half of all the stillbirths (54 per 1,000 deliveries) occur in the peripartum period. Understanding the predictors of preventable stillbirths (SB) will inform the formulation of strategies to reduce this preventable loss of newborns in the intrapartum period. The objective of this study was to determine the predictors of intrapartum stillbirth among women delivering at Mulago National Referral and Teaching Hospital in Central Uganda. Methods: This was an unmatched case-control study conducted at Mulago Hospital from October 29, 2018 to October 30, 2019. A total of 474 women were included in the analysis: 158 as cases with an intrapartum stillbirth and 316 as controls without an intrapartum stillbirth. Bivariable and multivariable logistic regression was done to determine the predictors of intrapartum stillbirth. Results: The predictors of intrapartum stillbirth were history of being referred from lower health units to Mulago hospital (aOR 2.5, 95% CI:1.5-4.5); maternal age 35 years or more (aOR 2.9, 95% CI:1.01-8.4); antepartum hemorrhage (aOR 8.5, 95% CI:2.4-30.7); malpresentation (aOR 6.29; 95% CI:2.39-16.1); prolonged/obstructed labor (aOR 6.2; 95% CI:2.39-16.1); and cesarean delivery (aOR 7.6; 95% CI:3.2-13.7). Conclusion and Global Health Implications: Referral to hospital, maternal age 35 years and above, obstetric complication during labor, and cesarean delivery were predictors of intrapartum stillbirth in women delivering at Mulago hospital. Timely referral and improving access to quality intrapartum obstetric care have the potential to reduce the incidence of intrapartum SB in our community. Copyright © 2021 Kiondo et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.
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Matanock, Almea, Thomas Emeetai, Lilian Likicho, et al. "Integrating Water Treatment into Antenatal Care: Impact on Use of Maternal Health Services and Household Water Treatment by Mothers—Rural Uganda, 2013." American Journal of Tropical Medicine and Hygiene 94, no. 5 (2016): 1150–56. http://dx.doi.org/10.4269/ajtmh.15-0356.
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Murokora, D., J. Beyeza, and F. Kaharuza. "I262 ADVOCATING FOR IMPROVEMENT OF MATERNAL AND CHILD HEALTH SERVICES IN UGANDA: THE ROLE OF THE NATIONAL OBSTETRICS & GYNAECOLOGICAL PROFESSIONAL ASSOCIATION." International Journal of Gynecology & Obstetrics 119 (October 2012): S228. http://dx.doi.org/10.1016/s0020-7292(12)60292-6.
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Matthews, Lynn T., Francis Bajunirwe, Jasmine Kastner, et al. "“I Always Worry about What Might Happen Ahead”: Implementing Safer Conception Services in the Current Environment of Reproductive Counseling for HIV-Affected Men and Women in Uganda." BioMed Research International 2016 (2016): 1–9. http://dx.doi.org/10.1155/2016/4195762.
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Background.We explored healthcare provider perspectives and practices regarding safer conception counseling for HIV-affected clients.Methods.We conducted semistructured interviews with 38 providers (medical and clinical officers, nurses, peer counselors, and village health workers) delivering care to HIV-infected clients across 5 healthcare centres in Mbarara District, Uganda. Interview transcripts were analyzed using content analysis.Results.Of 38 providers, 76% were women with median age 34 years (range 24–57). First, we discuss providers’ reproductive counseling practices. Emergent themes include that providers (1) assess reproductive goals of HIV-infected female clients frequently, but infrequently for male clients; (2) offer counseling focused on “family planning” and maternal and child health; (3) empathize with the importance of having children for HIV-affected clients; and (4) describe opportunities to counsel HIV-serodiscordant couples. Second, we discuss provider-level challenges that impede safer conception counseling. Emergent themes included the following: (1) providers struggle to translate reproductive rights language into individualized risk reduction given concerns about maternal health and HIV transmission and (2) providers lack safer conception training and support needed to provide counseling.Discussion.Tailored guidelines and training are required for providers to implement safer conception counseling. Such support must respond to provider experiences with adverse HIV-related maternal and child outcomes and a national emphasis on pregnancy prevention.
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Brenner, Jennifer L., Dismas Matovelo, Boniphace Maendaelo, et al. "65 Mama na Mtoto: Health Outcome Achievements Following Implementation of Comprehensive Maternal Newborn Programming in Rural Tanzania." Paediatrics & Child Health 25, Supplement_2 (2020): e27-e27. http://dx.doi.org/10.1093/pch/pxaa068.064.
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Abstract Introduction/Background Preventable deaths in pregnant women and newborns remain unacceptably high in East Africa. Limited antenatal, delivery and postnatal care-seeking combined with service delivery gaps at government facilities contribute to high mortality. Between 2016-2019, partners from Tanzania, Uganda, and Canada jointly developed, implemented, and evaluated a comprehensive, district-wide maternal, newborn, and child health (MNCH) ‘package’ in Lake Zone, Tanzania. Known locally as ‘Mama na Mtoto’, the scale-up programming involved training and capacity building for district managers, health facility staff and a network of volunteer community health workers selected by their own communities. Objectives To quantitatively assess changes in MNCH health outcomes following the Mama na Mtoto intervention. Design/Methods MNCH household-level care-seeking outcomes were assessed using a pre/post coverage survey adapted from the Demographic Health Survey. Households and women (15-49 years), selected through cluster sampling (cluster unit=hamlet), were surveyed by local, trained research assistants using tablet-based surveys. MNCH service outcomes were assessed at all government health facilities using a comprehensive pre/post cross-sectional audit tool; key measures included staff, equipment, infrastructure, supplies, and medication availability. Descriptive statistics for antenatal care (ANC), health facility delivery (HFD), and postnatal care (PNC)-related indicators were analyzed pre- and post-intervention using R software. Composite health facility ‘Readiness Scores’ were calculated through tallies of relevant itemized facility-based measures for each core MNCH service area across the district. Absolute percentage differences, confidence intervals and design effect are presented where relevant. Results In total, 1,977 households, 2,438 women, and 45 health facilities were surveyed pre-intervention and 1,835 homes, 2,073 women, and 49 health facilities were surveyed post. Care-seeking indicators with statistically significant changes were ANC 4+ (+11%), ANC &lt;12 weeks (+7%), HFD (+17%), and PNC for mothers (+9%); PNC for babies was not significant. Increases in composite MNCH Service Readiness Scores were as follows: ANC +24%, essential newborn care +42%, newborn resuscitation +37%, and labour and delivery +27%. Conclusion The comprehensive MnM package was associated with important improvements in the demand (care-seeking) and service (facility readiness) health outcomes. Attribution is complicated by an uncontrolled health system and lack of district controls; however, the extensive scope, reach, and positive changes are promising and consistent with sustained Ugandan experiences. Best practice documentation is critical to facilitate scale-up and progress acceleration of MNCH programs in Tanzanian and East African settings.
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Waniala, Isaac, Sandra Nakiseka, Winnie Nambi, et al. "Prevalence, Indications, and Community Perceptions of Caesarean Section Delivery in Ngora District, Eastern Uganda: Mixed Method Study." Obstetrics and Gynecology International 2020 (July 20, 2020): 1–11. http://dx.doi.org/10.1155/2020/5036260.
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Background. Uganda has a high maternal mortality ratio (MMR) of 336/100,000 live births. Caesarean section is fundamental in achieving equity and equality in emergency obstetric care services. Despite it being a lifesaving intervention, it is associated with risks. There has been a surge in caesarean section rates in some areas, yet others remain underserved. Studies have shown that rates exceeding 15% do not improve maternal and neonatal morbidity and mortality. Our study aimed at determining the prevalence, indications, and community perceptions of caesarean section delivery in Eastern Uganda. Methods and Materials. It was both health facility and commuity based cross-sectional descriptive study in Ngora district, Eastern Uganda. Mixed methods of data collection were employed in which quantitative data were collected by retrospectively reviewing all charts of all the mothers that had delivered at the two comprehensive emergency obstetric care service facilities between April 2018 and March 2019. Qualitative data were collected by focus group discussions till point of saturation. Data were entered into EpiData (version 3.1) and analyzed using SPSS software (version 24). Qualitative data analysis was done by transcribing and translating into English verbatim and then analyzed into themes and subthemes with the help of NVIVO 12. Results. Of the total 2573 deliveries, 14% (357/2573) were by CS. The major single indications were obstructed labour 17.9%, fetal distress 15.3%, big baby 11.6%, and cephalopelvic disproportion (CPD) 11%. Although appreciated as lifesaving for young mothers, those with diseases and recurrent intrauterine fetal demise, others considered CS a curse, marriage-breaker, misfortune, money-maker and a sign of incompetent health workers, and being for the lazy women and the rich civil servants. The rise was also attributed to intramuscular injections and contraceptive use. Overall, vaginal delivery was the preferred route. Conclusion. Several misconceptions that could hinder access to CS were found which calls for more counseling and male involvement. Although facility based, the rate is higher than the desired 5–15%. It is higher than the projected increase of 36% by 2021. It highlights the need for male involvement during counseling and consent for CS and concerted efforts to demystify community misconceptions about women that undergo CS. These misconceptions may be a hindrance to access to CS.
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Kastner, Jasmine, Lynn T. Matthews, Ninsiima Flavia, et al. "Antiretroviral Therapy Helps HIV-Positive Women Navigate Social Expectations for and Clinical Recommendations against Childbearing in Uganda." AIDS Research and Treatment 2014 (2014): 1–9. http://dx.doi.org/10.1155/2014/626120.
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Understanding factors that influence pregnancy decision-making and experiences among HIV-positive women is important for developing integrated reproductive health and HIV services. Few studies have examined HIV-positive women’s navigation through the social and clinical factors that shape experiences of pregnancy in the context of access to antiretroviral therapy (ART). We conducted 25 semistructured interviews with HIV-positive, pregnant women receiving ART in Mbarara, Uganda in 2011 to explore how access to ART shapes pregnancy experiences. Main themes included: (1) clinical counselling about pregnancy is often dissuasive but focuses on the importance of ART adherence once pregnant; (2) accordingly, women demonstrate knowledge about the role of ART adherence in maintaining maternal health and reducing risks of perinatal HIV transmission; (3) this knowledge contributes to personal optimism about pregnancy and childbearing in the context of HIV; and (4) knowledge about and adherence to ART creates opportunities for HIV-positive women to manage normative community and social expectations of childbearing. Access to ART and knowledge of the accompanying lowered risks of mortality, morbidity, and HIV transmission improved experiences of pregnancy and empowered HIV-positive women to discretely manage conflicting social expectations and clinical recommendations regarding childbearing.
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HARTTER, JOEL, JENNIFER SOLOMON, SADIE J. RYAN, SUSAN K. JACOBSON, and ABE GOLDMAN. "Contrasting perceptions of ecosystem services of an African forest park." Environmental Conservation 41, no. 4 (2014): 330–40. http://dx.doi.org/10.1017/s0376892914000071.
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SUMMARYTraditionally, conservation programmes assume that local peoples’ support for parks depends on receiving material benefits from foreign exchange, tourism, development and employment. However, in the case of forest parks in Africa, where annual visitation can be small, local support may instead result from ecosystem services. Kibale National Park, a forest park in Uganda, demonstrates that people appreciate parks in ways that are seldom cited nor explored. Public perceptions of benefits accrued from Kibale were explored using two different sampling techniques: a community census and a geographic sample. In both surveys, over 50% of respondents perceived benefits provided by Kibale National Park, and over 90% of those who perceived benefits identified ecosystem services, whereas material benefits were cited less frequently. Multimodel selection on a suite of general linear models for the two different sampling methods provided a comparison of factors influencing perceptions of ecosystem services. Perceptions of Park benefits were influenced by geography, household and respondent characteristics, and perception of negative impacts from the Park. Perceived ecosystem benefits played an important role in the way the Park was viewed and valued locally. Parks have considerable impacts on neighbouring communities, and their long-term political and economic sustainability depends on managing these relationships well. Since local people have the most to gain or lose by conserving neighbouring parks, analyses that incorporate the perceptions of local people are essential to management and sustainability of park landscapes.
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Meyer, Amanda J., Mari Armstrong-Hough, Diana Babirye, et al. "Implementing mHealth Interventions in a Resource-Constrained Setting: Case Study From Uganda." JMIR mHealth and uHealth 8, no. 7 (2020): e19552. http://dx.doi.org/10.2196/19552.
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Background Mobile health (mHealth) interventions are becoming more common in low-income countries. Existing research often overlooks implementation challenges associated with the design and technology requirements of mHealth interventions. Objective We aimed to characterize the challenges that we encountered in the implementation of a complex mHealth intervention in Uganda. Methods We customized a commercial mobile survey app to facilitate a two-arm household-randomized, controlled trial of home-based tuberculosis (TB) contact investigation. We incorporated digital fingerprinting for patient identification in both study arms and automated SMS messages in the intervention arm only. A local research team systematically documented challenges to implementation in biweekly site visit reports, project management reports, and minutes from biweekly conference calls. We then classified these challenges using the Consolidated Framework for Implementation Research (CFIR). Results We identified challenges in three principal CFIR domains: (1) intervention characteristics, (2) inner setting, and (3) characteristics of implementers. The adaptability of the app to the local setting was limited by software and hardware requirements. The complexity and logistics of implementing the intervention further hindered its adaptability. Study staff reported that community health workers (CHWs) were enthusiastic regarding the use of technology to enhance TB contact investigation during training and the initial phase of implementation. After experiencing technological failures, their trust in the technology declined along with their use of it. Finally, complex data structures impeded the development and execution of a data management plan that would allow for articulation of goals and provide timely feedback to study staff, CHWs, and participants. Conclusions mHealth technologies have the potential to make delivery of public health interventions more direct and efficient, but we found that a lack of adaptability, excessive complexity, loss of trust among end users, and a lack of effective feedback systems can undermine implementation, especially in low-resource settings where digital services have not yet proliferated. Implementers should anticipate and strive to avoid these barriers by investing in and adapting to local human and material resources, prioritizing feedback from end users, and optimizing data management and quality assurance procedures. Trial Registration Pan-African Clinical Trials Registration PACTR201509000877140; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=877
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Bein, Murad. "The association between medical spending and health status: A study of selected African countries." Malawi Medical Journal 32, no. 1 (2020): 37–44. http://dx.doi.org/10.4314/mmj.v32i1.8.
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BackgroundThe report from the World Health Organization (WHO) reveals that health spending worldwide remains highly unequal as more than 80% of the world’s population live in low and middle-income countries but only account for about 20% of global health expenditure. Another report by the WHO on the state of health financing in Africa published in 2013 intimates that countries that are part of their member states are still on the average level in meeting set goals in financing key health projects. ObjectiveThe study set out to investigate the association between public and private spending and health status for eight selected African countries, namely Burundi, Eritrea, Ethiopia, Kenya, Rwanda, Sudan, Tanzania and Uganda. Health status indicators include the incidence of tuberculosis, mortality rates, maternal deaths and prevalence of HIV. MethodsDescriptive statistics and pairwise correlation are used to assess the relationship between healthcare spending and health status. Random and fixed effect models are further employed to provide insights into the association between descriptive statistics and pairwise correlation. We used annual data from the year 2000 to 2014 obtained from world development indicators.ResultsThe relationship between healthcare spending (public and private) and health status is statistically significant. Public healthcare expenditure has a higher association than private expenditure in reducing the mortality rate, tuberculosis and HIV for the average country in our sample. For example, an increase in public healthcare spending is negatively associated and statistically significant at 5% or better in reducing female mortality, male mortality, tuberculosis and HIV. Private healthcare spending is more impactful in the area of maternal deaths, where it is associated negatively and statistically significant at 1%. An increase in private healthcare spending is linked to a reduction in maternal deaths. We also compared the association between an increase in healthcare spending on males versus females and observed that public health expenditure impacts the health status of both sexes equally, however, private health expenditure provides a greater positive benefit to males. It is worth remembering that two goals of the United Nations agenda on sustainable development are gender equality and ensuring healthcare for all. ConclusionThe findings of this research call for the selected African countries to pay more attention to public healthcare expenditure in order to improve health status, especially since private healthcare which provides access to healthcare facilities for some poor people leads to costs that are a burden. So, future research should focus on analyzing components of private healthcare spending such as direct household out-of-pocket spending, private insurance and direct service payments by private corporations as dependent variables to understand what form of private investment should be encouraged.
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Di Giorgio, Laura, David K. Evans, Magnus Lindelow, et al. "Analysis of clinical knowledge, absenteeism and availability of resources for maternal and child health: a cross-sectional quality of care study in 10 African countries." BMJ Global Health 5, no. 12 (2020): e003377. http://dx.doi.org/10.1136/bmjgh-2020-003377.
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ObjectiveAssess the quality of healthcare across African countries based on health providers’ clinical knowledge, their clinic attendance and drug availability, with a focus on seven conditions accounting for a large share of child and maternal mortality in sub-Saharan Africa: malaria, tuberculosis, diarrhoea, pneumonia, diabetes, neonatal asphyxia and postpartum haemorrhage.MethodsWith nationally representative, cross-sectional data from ten countries in sub-Saharan Africa, collected using clinical vignettes (to assess provider knowledge), unannounced visits (to assess provider absenteeism) and visual inspections of facilities (to assess availability of drugs and equipment), we assess whether health providers are available and have sufficient knowledge and means to diagnose and treat patients suffering from common conditions amenable to primary healthcare. We draw on data from 8061 primary and secondary care facilities in Kenya, Madagascar, Mozambique, Nigeria, Niger, Senegal, Sierra Leone, Tanzania, Togo and Uganda, and 22 746 health workers including doctors, clinical officers, nurses and community health workers. Facilities were selected using a multistage cluster-sampling design to ensure data were representative of rural and urban areas, private and public facilities, and of different facility types. These data were gathered under the Service Delivery Indicators programme.ResultsAcross all conditions and countries, healthcare providers were able to correctly diagnose 64% (95% CI 62% to 65%) of the clinical vignette cases, and in 45% (95% CI 43% to 46%) of the cases, the treatment plan was aligned with the correct diagnosis. For diarrhoea and pneumonia, two common causes of under-5 deaths, 27% (95% CI 25% to 29%) of the providers correctly diagnosed and prescribed the appropriate treatment for both conditions. On average, 70% of health workers were present in the facilities to provide care during facility hours when those workers are scheduled to be on duty. Taken together, we estimate that the likelihood that a facility has at least one staff present with competency and key inputs required to provide child, neonatal and maternity care that meets minimum quality standards is 14%. On average, poor clinical knowledge is a greater constraint in care readiness than drug availability or health workers’ absenteeism in the 10 countries. However, we document substantial heterogeneity across countries in the extent to which drug availability and absenteeism matter quantitatively.ConclusionOur findings highlight the need to boost the knowledge of healthcare workers to achieve greater care readiness. Training programmes have shown mixed results, so systems may need to adopt a combination of competency-based preservice and in-service training for healthcare providers (with evaluation to ensure the effectiveness of the training), and hiring practices that ensure the most prepared workers enter the systems. We conclude that in settings where clinical knowledge is poor, improving drug availability or reducing health workers’ absenteeism would only modestly increase the average care readiness that meets minimum quality standards.
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Kigozi, Fred. "Mental health services in Uganda." International Psychiatry 2, no. 7 (2005): 15–18. http://dx.doi.org/10.1192/s1749367600007104.
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Uganda is a landlocked developing country in East Africa with an estimated population of 24.8 million people (2002 census). At independence (in 1962) Uganda was a very prosperous and stable country, with enviable medical services in the region. This, however, was destroyed by a tyrant military regime and the subsequent civil wars up to 1986, when the current government took over the reigns of power.
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Lund, C., A. Alem, M. Schneider, et al. "Generating evidence to narrow the treatment gap for mental disorders in sub-Saharan Africa: rationale, overview and methods of AFFIRM." Epidemiology and Psychiatric Sciences 24, no. 3 (2015): 233–40. http://dx.doi.org/10.1017/s2045796015000281.
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There is limited evidence on the acceptability, feasibility and cost-effectiveness of task-sharing interventions to narrow the treatment gap for mental disorders in sub-Saharan Africa. The purpose of this article is to describe the rationale, aims and methods of the Africa Focus on Intervention Research for Mental health (AFFIRM) collaborative research hub. AFFIRM is investigating strategies for narrowing the treatment gap for mental disorders in sub-Saharan Africa in four areas. First, it is assessing the feasibility, acceptability and cost-effectiveness of task-sharing interventions by conducting randomised controlled trials in Ethiopia and South Africa. The AFFIRM Task-sharing for the Care of Severe mental disorders (TaSCS) trial in Ethiopia aims to determine the acceptability, affordability, effectiveness and sustainability of mental health care for people with severe mental disorder delivered by trained and supervised non-specialist, primary health care workers compared with an existing psychiatric nurse-led service. The AFFIRM trial in South Africa aims to determine the cost-effectiveness of a task-sharing counselling intervention for maternal depression, delivered by non-specialist community health workers, and to examine factors influencing the implementation of the intervention and future scale up. Second, AFFIRM is building individual and institutional capacity for intervention research in sub-Saharan Africa by providing fellowship and mentorship programmes for candidates in Ethiopia, Ghana, Malawi, Uganda and Zimbabwe. Each year five Fellowships are awarded (one to each country) to attend the MPhil in Public Mental Health, a joint postgraduate programme at the University of Cape Town and Stellenbosch University. AFFIRM also offers short courses in intervention research, and supports PhD students attached to the trials in Ethiopia and South Africa. Third, AFFIRM is collaborating with other regional National Institute of Mental Health funded hubs in Latin America, sub-Saharan Africa and south Asia, by designing and executing shared research projects related to task-sharing and narrowing the treatment gap. Finally, it is establishing a network of collaboration between researchers, non-governmental organisations and government agencies that facilitates the translation of research knowledge into policy and practice. This article describes the developmental process of this multi-site approach, and provides a narrative of challenges and opportunities that have arisen during the early phases. Crucial to the long-term sustainability of this work is the nurturing and sustaining of partnerships between African mental health researchers, policy makers, practitioners and international collaborators.
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Bulatao, Rodolfo A., and John A. Ross. "Which health services reduce maternal mortality? Evidence from ratings of maternal health services." Tropical Medicine and International Health 8, no. 8 (2003): 710–21. http://dx.doi.org/10.1046/j.1365-3156.2003.01083.x.
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Dodge, Cole P. "Uganda—rehabilitation, or redefinition of health services?" Social Science & Medicine 22, no. 7 (1986): 755–61. http://dx.doi.org/10.1016/0277-9536(86)90227-3.
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Mutungi, Fredrick, Fredrick Mutungi, Rehema Baguma, and Dr Annabella Basaza-Ejiri. "Model for context-fitting mobile services for monitoring delivery of public health services." American Journal of Data, Information and Knowledge Management 2, no. 1 (2021): 1–23. http://dx.doi.org/10.47672/ajdikm.660.
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Purpose: The study aimed at establishing the contextual factors affecting performance of mobile services for monitoring delivery of public health services in Uganda.
 Methodology: The study used a qualitative research design in an interpretivist paradigm where the identified factors were subjected to analysis using documentary evidence and qualitative data from interviews. Using purposive sampling, six case studies among institutions responsible for monitoring health service delivery in Uganda were selected. Data was categorized through creating code families, grouping codes with similar attributes into broad categories and represent a higher order grouping of data from which the researcher began to build conceptual model and categories continued until saturation point.
 Findings: It was established that lack of power for charging mobile devices, limited content and coverage of data captured by mobile technologies, limited man power, knowledge and skills of using mobile technologies and poor attitude of health workers, general nature of some mobile technologies, language barrier, poor connectivity and reliability of mobile and internet networks, insufficient supplies of health data collection and processing tools affect the performance of mobile services for monitoring delivery of public health services in Uganda.
 Contribution to policy and practice: The study significantly contributes to a large body of knowledge in the adoption and use mobile technologies in monitoring delivery of public health services that has been less investigated in Uganda.
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PIROUET, M. LOUISE. "Crisis in Uganda: the breakdown of health services." African Affairs 89, no. 356 (1990): 470–72. http://dx.doi.org/10.1093/oxfordjournals.afraf.a098322.
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Cook, G. C. "Crisis in Uganda: the Breakdown of Health Services." Postgraduate Medical Journal 62, no. 729 (1986): 703–4. http://dx.doi.org/10.1136/pgmj.62.729.703-b.
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Edwards, Grace. "From policy to practice: the challenges facing Uganda in reducing maternal mortality." International Journal of Health Governance 23, no. 3 (2018): 226–32. http://dx.doi.org/10.1108/ijhg-06-2017-0031.
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Purpose The purpose of this paper is to describe the challenges faced by health professionals in meeting Millennium Goal 5 and reducing maternal mortality in Uganda. Design/methodology/approach Uganda is a low income land locked country with some major challenges around maternal health. There are many comprehensive and visionary plans produced by the Ugandan Government, however, there is a disconnect between policy and practice and there are many barriers to be addressed in order to reduce maternal mortality in Uganda. Findings Despite making considerable progress in reducing maternal mortality, Millenium Development Goal (MDG) 5 was not achieved and every day 300 children and 20 mothers die in Uganda. Major barriers include lack of resources, both human and equipment, disparities in access to care, lack of clinical skills and knowledge and financial constraints. The Millennium goals are now behind us and focus has shifted to the sustainable development goals (SDGs). The Ugandan Government must focus on using these goals as part of developing the maternal and child health strategy by prioritising the human resource and health financial issues and continuing to work towards reducing maternal and perinatal mortality. Originality/value This paper gives a succinct review of the progress of Uganda towards meeting the Millennium Goal 5 and makes key recommendations for addressing SDG 3.
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Sheldon, Nasaruddin, Sapruddin Perwira, Kristina Gryboski, and Laxmikant Palo. "Providing Maternal Health Services At Factories." Health Affairs 35, no. 9 (2016): 1740. http://dx.doi.org/10.1377/hlthaff.2016.0760.
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