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1
Balikowa, David Ouma. "The human rights-based approach to public health: an inquiry into the challenges of its adoption in Uganda." Thesis, University of the Western Cape, 2012. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_9712_1365583578.
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Knowledge about the challenges in adopting the Human Rights Based Approach (HRBA) to public health is still limited, necessitating an exploration into the subject. The purpose of this study is to contribute to strengthening the implementation of the HRBA to public health in Uganda. The aim was to explore challenges to the implementation of this approach The objectives of this study were to examine whether there is a shared understanding and agreement among stakeholders about the meaning and potential value of the Human Rights Based Approach (HRBA) to public health, and to describe stakeholders&lsquo
perceptions on the challenges to the adoption and implementation of the HRBA to public health.
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Kamoga, Edward Nelson B. "Monitoring resource allocation at the district level in Uganda: implications and challenges." Master's thesis, University of Cape Town, 2004. http://hdl.handle.net/11427/8632.
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Includes bibliographical references.Like most developing countries, Uganda works on a very tight health budget and the government has to ensure strict principles of efficiency and equity in the allocation and use of the minimal resources. One of the strategies in the process of improving delivery of public services has been to decentralise them. The district local government is responsible for the planning process, data management, resource allocation and co-ordination with the central government. However the capacity of the districts to stick to the principles of efficiency and equity is not a given. In Uganda, the health system has been further devolved with the creation of health sub- districts. Because there are no clear guidelines from both local and central governments on how to ensure equity in resource allocation at the district level there have been arguments that resources from the centre to the district are not necessarily equitably allocated at the sub- district. The principle of equity that would seem of relevance in this case is that of providing resources to those in most need (most deprived) given the minimal resources available. This study was done to assess how health resources are allocated between sub-districts relative to the level of need/deprivation in each sub district and in the process suggest a resource allocation formula for the district. Using mainly data from a rapid household hold survey and simple additive averaging to aggregate variables to create a deprivation index, the study showed that three sub-districts in Luwero district differed in the level of deprivation and the most deprived sub-district was actually under-resourced. The study therefore showed that there is room for using simple indices in a resource allocation formula at the district level so that budgets in the future are allocated to the most deprived areas hence maintaining the central government goal of ensuring equity in the use and allocation of minimal resources that are usually available.
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Hernandez, Arielle G. "Effective strategies used to describe and address the burden of sickle cell disease in the Republic of Uganda: The Uganda Sickle Surveillance Study." University of Cincinnati / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1459438302.
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Saran, Indrani. "Health Behaviors in the Context of Malaria Treatment in Uganda." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:27201735.
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Malaria is a major cause of morbidity and mortality worldwide, particularly among young children in Sub-Saharan Africa. There exists a very effective treatment for malaria, a class of drugs known as artemisinin-based combination therapies (ACTs). However, it is estimated that only 12-22% of children with malaria were treated with an ACT in 2015 and, even when people take ACTs, they do not always complete the full treatment course. This dissertation examines malaria treatment behaviors in Central and Eastern Uganda.
The first two chapters of this dissertation use a randomized controlled trial to evaluate interventions designed to increase patient adherence to the ACT treatment regimen. We find that 35% of patients who purchase subsidized ACTs from local drug shops in central Uganda do not complete the full 3-day treatment course. In the first chapter, we show that patients who felt better mid-way through treatment were more likely to stop taking the medication than those who were still unwell. However, short messages promoting adherence, delivered via stickers affixed to the standard ACT package, increased adherence rates by approximately 9%.
The second chapter examines the impact of diagnostic testing for malaria on adherence to the malaria treatment regimen. Since most people do not receive a confirmed diagnosis of malaria before beginning treatment, uncertainty about the true cause of illness may be a factor in nonadherence. We find that patients who tested positive for malaria on a rapid diagnostic test did not have higher odds of adherence. However, we present some evidence that patients who tested positive were more likely to consume a few additional pills of the drug.
The third chapter of this dissertation shows that the probability that a febrile patient has malaria declines substantially with the age of the patient and increases with the local village prevalence rate. We find, however, that ACT treatment rates are invariant to age and local prevalence, and beliefs about whether an illness is malaria also do not vary with age or prevalence. This work suggests that mis-perceptions of malaria risk may be contributing to the under-treatment of malaria in young children.
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Kuhanen, Jan. "Poverty, health, and reproduction in early colonial Uganda /." Joensuu : Joensuun yliopisto/Faculty of Humanities, 2005. http://www.loc.gov/catdir/toc/fy0601/2005419946.html.
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Beatty, Kate, and Michael Meit. "Opportunities and Challenges Facing Rural Public Health Agencies." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6835.
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Mayanja, Rehema. "Decentralized health care services delivery in selected districts in Uganda." Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&.
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Decentralization of health services in Uganda, driven by the structural adjustment programme of the World Bank, was embraced by government as a means to change the health institutional structure and process delivery of health services in the country. Arising from the decentralization process, the transfer of power concerning functions from the top administrative hierachy in health service provision to lower levels, constitutes a major shift in management, philosophy, infrastructure development, communication as well as other functional roles by actors at various levels of health care. This study focused its investigation on ways and levels to which the process of decentralization of health service delivery has attained efficient and effective provision of health services. The study also examined the extent to which the shift of health service provision has influenced the role of local jurisdictions and communities. Challenges faced by local government leaders in planning and raising funds in response to decentralized health serdelivery were examined.
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Pearson, Georgina. "Global health, local realities : neglected diseases in northwestern Uganda." Thesis, London School of Economics and Political Science (University of London), 2015. http://etheses.lse.ac.uk/3303/.
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This thesis explores the everyday realities of neglected diseases among people living and working along the River Nile in Moyo and Adjumani Districts, northwestern Uganda. It is based on ethnographic-epidemiological fieldwork carried out over sixteen months during 2013 and 2014. The fieldwork included participant-observation, in-depth interviews and a parasitological survey with structured questionnaire. This thesis takes an interdisciplinary approach in studying global health, contributing to literature at the intersection between medicine and anthropology. The neglected tropical diseases are a group of diverse diseases framed in global health around common socio-economic-political features, persisting in poverty. They affect neglected populations, neglected by public health policy. Current approaches to their management are largely a collection of technical, diseasefocused programmes that disregard the politics of poverty. Contemporary debates surround the side-lining of social science literature, and the evidence behind the biomedically focussed disease control programmes. Fisherfolk are said to be vulnerable to a number of these diseases. Diseases such as intestinal schistosomiasis (one of the neglected tropical diseases) persist in fishing areas despite a global public health programme. However, as this study demonstrates, in northwestern Uganda levels of schistosomiasis infection appear to have reduced. This study situates the success of the global health control programme within the local biosocial context. Furthermore, it shows that while one neglected tropical disease is controlled, other diseases persist and emerge. These other diseases explored in this research were Buruli ulcer and Hepatitis B, diseases that challenged the global health concept of neglected tropical diseases. This thesis contributes methodologically to the growing interdisciplinary field of global health. It provides empirically-based biosocial evidence of the local realities of neglected diseases. In taking this approach, it argues that this concept is misleading. While it has illuminated particular problems in global health, the restrictive gaze disregards local public health concerns.
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Karlsen, Klaus. "Threatened child health through lack of immunization, identification of risk groups in Uganda." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1995. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/mq21994.pdf.
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Nahamya, David. "Assessment of essential drug management in the public health facilities in Uganda." Master's thesis, University of Cape Town, 2007. http://hdl.handle.net/11427/9460.
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Includes bibliographical references (leaves 74-78).The main aim of the study is to evaluate the management of essential drugs in thepublic health facilities in Uganda. This is a cross-sectional study carried out in the districts of Kampala and Mbale employing both qualitative and quantitative methods. Standard outcome indicators as described in the WHO Operational Package for Monitoring and Assessing the Pharmaceutical Situation in Countries are adapted and used in this study.
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Tärnström, Elin, and Mariella Wallin. "Ugandan women's thoughts and experiences about their health." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-240114.
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SAMMANFATTNING Hälsan påverkas av många olika faktorer var av vissa inte är möjliga att påverka, där ibland ålder, kön och medfödda tillstånd. Livsstilsfaktorer är möjliga att påverka men socioekonomiska-, kulturella- och miljömässiga faktorer kan vara svåra att påverka som individ. Socioekonomiska faktorer som inkomst och utbildning påverkar kvinnors hälsa i större utsträckning då kvinnor är mer sårbara jämfört med män, särskilt i låginkomstländer. Syfte: Syftet med studien var att undersöka hur Ugandiska kvinnor upplevelse sin hälsa, vilka faktorer de tror påverkar den, om de gör något för att förbättra sin hälsa samt om de oroar sig över sin hälsa. Metod: Studien var en explorerande kvalitativ intervjustudie. Intervjuerna var semistrukturerade och 16 kvinnor blev intervjuade i Kampala, Uganda. Inklusionskriterierna för att delta var att kvinnorna skulle vara 18 år eller äldre och att de inte led av någon allvarlig sjukdom eller begränsning som gjorde det svårt att förstå och delta i studien. Resultat: Fyra teman identifierades under analysen; ”Upplevelsen av hälsa är individuell”;”Att oroa sig påverkar hälsan negativt”; ”Hälsan påverkas av många olika faktorer” och ”Små handlingar kan förbättra hälsan om du har tid och pengar”. Kvinnorna i studien upplevde generellt god hälsa. Dålig hälsa beskrevs på grund av ålder, upplevelser av våld i nära relation samt brist på pengar för att kunna köpa HIV-medicin. Olika faktorer påverkade kvinnornas hälsa där majoriteten av kvinnorna nämnde bristen av pengar som en viktig faktor Slutsats: Ugandiska kvinnor upplevde generellt sin hälsa som bra. Det förekom att kvinnorna upplevde god hälsa trots att de levde med en allvarlig sjukdom, som hypertension eller HIV. Detta stämmer överens med WHO:s hälsodefinition samt Benner and Wrubel's omvårdnadsteori, som båda nämner att god hälsa inte bara är beroende av frånvaron av sjukdom utan också den individuella upplevelsen av hälsa och välbefinnande. Kvinnorna oroade sig över sin hälsa och pengar togs upp som en faktor som hade stor inverkan på deras hälsa. Studiens resultat stödjer att vissa hälsofaktorer är svåra att påverka som en individ, vilket gör det viktigt för sjukvårdspersonal att ha ett holistiskt förhållningssätt i mötet med patienten.ABSTRACT Various factors affect the health and some of them are impossible to prevent, among them are age, sex and constitutional conditions. Lifestyle factors are possible to influence but socioeconomic-, cultural- and environmental factors can be hard to prevent as an individual. Socioeconomic factors as income and education affect women's health to a large extent since they are more vulnerable compared to men, especially in low-income countries. Purpose: The aim of the study was to explore how Ugandan women experience their health, the factors they think affects it, if they do anything to improve their health and if they have any worries about their health. Method: The study was an explorative qualitative interview study. The interviews were semi-structured and 16 women were interviewed in Kampala, Uganda. The selection criteria's for the study were that the women should be 18 years and above and that they didn't suffer from severe illness or some disability that made it hard to understand and participate in the study. Results: Four themes where identified during the analyse; ”Experiences of health are individual”, ”Worrying affect your health in a bad way”, "Health is determined by many different factors ” and ”Small actions can improve your health if you have time and money”. The results showed that the women in the study experienced their health as generally good. Poor health was described because of problems of ageing, experience of domestic violence or lack of money for HIV-treatment. Different factors affected the women's health and most of them mentioned the lack of money as an important factor. Conclusion: Ugandan women express their health as good in general. It occurred that the women expressed good health even if they were living with a severe disease, such as hypertension or HIV. This consists with WHO's definition about health and Benner and Wrubel's nursing theory, which both mentions that good health is not only about the absence of disease but also about the individual experience about health. The women were worried about their health. Lack of money was brought up as a factor that had a great impact on their health. The findings of this study also support that some health-factors are hard to influence as an individual, which makes it important for healthcare workers to have an holistic approach in the meating with the patient.
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Kikule, Kate. "Review of drug financing and expenditure in Uganda : sustainability and improved access to essential medicines." Master's thesis, University of Cape Town, 2006. http://hdl.handle.net/11427/8914.
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Includes bibliographical references (leaves 73-80).Drugs are an important factor of production in health care. They constitute a significant proportion of health care expenditure in both developed and developing countries rendering financing of drugs an important health care concern. Previous studies have focused on health care financing in general and less on drug financing specifically and more so in least developed countries. This study therefore aims to provide an overview of the drug-financing situation in Uganda demonstrating the flow of funds for drugs in the health sector. The study further investigates whether the available financial resources could be sustained over time and assesses financial sustainability of resources for drugs in the public sector required to meet the drug component in the National Minimum Health Care Package. Data collection methods involved in-depth interviews with key informants in the relevant institutions and document reviews of financial records and other major relevant publications. The data obtained was analyzed using well-established methodologies. Financing mechanisms were analyzed using a framework consisting of aspects regarding viability, reliability and level of funding. The fund flows for drugs in the health sector were analyzed using the modified National Health Accounts methodology and finally financial sustainability was assessed using projections from the available financial resources. The study findings reveal a mix of financing mechanisms from both the public and the private sector employed to make drugs available to the population. The largest source of drug funding is out-of-pocket expenditure by households followed by central government tax revenue including donor support. There has been a noted increase in drug funding in the public sector though this is not adequate to cover the quantified drug need in the country. The size of the market for drugs increased over the review period (2001-2004) with an estimated total drug expenditure of 210 billion Uganda shillings. The projections show that the available financial resources for drugs will not be able to cover the predicted drug requirement within the National Minimum Health Care Package more so with the introduction of drugs required to treat new diseases like HIV/AIDS and the change to more expensive treatments for endemic diseases like malaria. The study concludes with policy recommendations urging government's commitment to allocate more resources to health and consequently to drugs so that there is less reliance on donor funding. It recommends that more effective means of utilizing available resources by mobilization of domestic resources including out-of-pocket payments through better-designed and well-managed health insurance schemes.
13
Owiny, Vincent. "Cost effectiveness of community-based (DOT) and self-supervised treatment of tuberculosis in Maracha Arua, Uganda." Master's thesis, University of Cape Town, 2002. http://hdl.handle.net/11427/9371.
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Bibliography: leaves 47-49.Tuberculosis is the leading infectious killer of people living with HIV/AIDS. Millions of tuberculosis deaths could be prevented by the widespread use of the less expensive strategy of directly observed treatment (DOT). The cost-effectiveness of DOT however varies with its method of supervision. This study evaluated the cost-effectiveness of community-based and self-supervision strategies of DOT in Maracha, Arua District, Uganda. Patients', community's and health system's costs were obtained through interviews and expenditure statements. For effectiveness measures, historical follow-up of the cohort belonging to each the tB treatmentt supervison strategy was done. Systematic random sampling was done to identify the 20 patients from each treatment strategy for interviews to estimate their treatment costs. Due to low number of patients in the available TB registers, all the 129 patients were enrolled for the study. The findings showed that community-based supervision of DOT was a more cost-effective TB treatment supervision option than that by self-supervision and was therefore recommended to Maracha HSD and Arua District for more support and expansion. However, the accuracy of this study was limited by method used and generalizability of the results could be affected by the small sample size.
14
Asiimwe, Sarah. "Use of health information for operational and strategic decision-making by division level managers of Kampala City Council Health Department." Thesis, University of the Western Cape, 2002. http://etd.uwc.ac.za/index.php?module=etd&.
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Mubangizi, Deus Bazira. "The public-private mix health care resources distribution implications for equity : Kampala district, Uganda." Master's thesis, University of Cape Town, 2002. http://hdl.handle.net/11427/9447.
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Bibliography: leaves 93-97.While in sociology, choice and equity have always co-existed; this has not been a subject of attention in the health care market. Following promotion of the public- private mix in the health care sector, there have been concerns that the pursuit of efficiency might compromise equity in accessing health care services. The main concern for this study was that the resulting relative health care resources distribution following public-private interaction has equity implications at the household level. Kampala district in Uganda was used to investigate this concern. Data collected from a household survey, key informant interviews and secondary data on health care resources distribution, was analyzed using STATA statistical package. The study findings indicated that the private health care sector in Uganda has grown in size and that it caters for more people in Kampala district than the public health care sector. The findings further indicated that households use private services due to the perceived high quality of services, availability of drugs, availability of doctors and other health workers and the nearness of private providers. On the other hand, public health services where used or preferred was due primarily to availability of doctors. Other findings indicated that there was a relationship between provider choice/use and the distribution of health care resources particularly; health workers and health care facilities. This applied both at household level and geographically. Utilization of health services also varied with distribution of the same resources. Private provider use was not solely dependent on income and hence ability to pay, but on other factors related to service characteristics such as perceived quality. The findings further show that there are inequities in financing health care services with low-income groups paying relatively more than high- income groups. The study proposes to policy makers a monitoring mechanism of the variables and outcome measures, both at household and sectoral level, in order to minimize inequities in access to health care. The study also recommends that a comprehensive regulatory framework needs to be set up to promote and control the activities of the private health sector in Uganda.
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Bergqvist, Sara, and Lisa Wieslander. "Waste management and health - A case study in Mbale, Uganda." Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-25366.
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Sophantering är av avgörande betydelse för folkhälsan i utvecklingsländer. I Uganda är ett av huvudproblemen för folkets hälsa den bristfälliga sophanteringen. För att fastställa problemet har vi genomfört en fallstudie under 10 veckor genom att studera hur sophanteringen fungerar i staden Mbale (Uganda) samt vilka konsekvenser denna får för befolkningens hälsa. Intervjuer, observationer och dokument har använts för att få en detaljerad beskrivning av fenomenet. Studien ger en bakgrund till vikten av en adekvat sophantering för folkets hälsa samt en introduktion till landet Uganda. I resultatet ges en utförlig beskrivning av hur sophanteringen ser ut i Industrial division, Mbale och vilka problem som påverkar den. I diskussionen redogörs för underliggande problem utifrån A. Sens teori Utveckling som frihet. B. Murphy’s modell The fourth dimension of health promotion används för att utvärdera det hälsoarbete som görs samt ge förslag till förbättring. Problemen kan sammanfattas genom att poängtera vikten av att samhället tar sitt ansvar för befolkningen bl.a. genom prioritering av infrastrukturen. Långsiktiga och hållbara lösningar bottnar i bekämpandet av korruption och fattigdom. Det förebyggande hälsoarbetet behöver förändras till att bli mer empowerment baserat.Waste management is of crucial concern for public health in developing countries. In Uganda one of the main problems connected to public health is a poor waste management system. To define the problem of waste management and to investigate its consequences for people’s health we made a case study during ten weeks in Mbale, Uganda. Interviews, observations and documents have been studied. Uganda as a country is introduced in the background and the importance of waste management for the public’s health is explained. An extensive description of how waste management works in Industrial division, Mbale and the problems affecting it is given in the results. In the discussion the underlying problems are described with the help of A Sen’s theory Development as freedom. B. Murpy’s model The fourth dimension of health promotion is used to evaluate the health promotion work that exists and to give suggestions of improvements. The problems can be summarised with the importance for the society to take responsibility for the population e.g. by prioritising the infrastructure. Sustainable and long-term solutions are grounded in combating corruption and poverty. A change in the health promotion work needs to be done and based upon empowerment.
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Musana, Imelda Atai Madgalene. "Effect of Access to Health Services on Neonatal Mortality in Uganda." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7828.
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Since 2006, Uganda has experienced a nonchanging neonatal mortality rate of 27 out of 1,000 live births, which is higher than the global average of 19 deaths for every 1,000 live births. The purpose of this retrospective cross-sectional study was to determine factors affecting access to health services and their impact on newborn deaths in Uganda. Mosley and Chen's model for child survival in developing nations provided the framework for the study. Secondary data from the 2016 demographic and health survey (UDHS) collected by the Uganda Bureau of Statistics (UBOs) was used. A total of 7,538 cases were used and analyzed using binary logistic regression and one-way analysis of covariance (ANCOVA). The results showed attending less than 4 antenatal care (ANC) visits during pregnancy increased the odds of neonatal deaths 1.57 times, while not taking antimalarial drugs during pregnancy increased the odds of neonatal deaths 1.67 times. However, receiving 4 or more tetanus toxoid (TT) vaccine doses before pregnancy was not statistically associated with an increased risk of neonatal death (p = .597). Also, there was no significant relationship between neonatal mortality and whether distance to health facilities was a challenge (p = .276) or receiving medical assistance during childbirth (p = .420). While there were significant differences in deaths of newborns in geographic regions while controlling for the number of ANC visits (p = .023), there were no differences while controlling for all three covariates, F(4, 117) = 2.00, p = .098. Findings may be used to inform government policies on ANC and malaria prevention during pregnancy, which may reduce neonatal mortality rates in Uganda.
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Othman, Taha, and Ioannis Karagiannis. "Harnessing 5G for Public Safety and Health : Challenges and Investment Areas." Thesis, Blekinge Tekniska Högskola, Institutionen för industriell ekonomi, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:bth-20130.
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The introduction of 5G technology in combination with smart cities will revolutionize the world economically and from the quality of life point of view. Different sectors will be impacted by this revolution such as (1) public health and safety, (2) mobility and transportation and (3) energy and water. This thesis will focus on Public Health and Safety. The characteristics that affect or boost the Return on Investment of 5G investments will be analyzed and a business model for the proper implementation of such investments will be presented. We will use the regression analysis to study the characteristics that affect the Return on Investment using 5G in Public Health and Safety. We will also use the VISOR model to define a business model for one of the services in Public Health and Safety namely the infectious disease surveillance. Our goal is to study this field of industry dynamics, technology and innovation and provide a holistic view from selecting the service up to identifying the business model.
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Tophill, Church. "Quality of Nutrition Services for Children and Pregnant Women in Ntungamo District, Uganda." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5426.
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Inadequate nutrition during infancy and early childhood seriously interferes with brain development, leading to neurological and behavioral disorders. Such effects are detrimental to children under 2 years of age. The purpose of this cross-sectional study was to better understand the quality of nutrition services offered to children and pregnant women in Ntungamo District in southwestern Uganda. The cross-sectional design facilitated comparison of different variables, using a research-question-driven approach, assessing existing secondary data from SPRING Uganda database. Stepwise, backward multiple logistic regression was used to identify the independent variables that influenced the provision of quality nutrition assessment, counseling, and support (NACS) services to clients. Only the independent variables with p < 0.05 were retained in the final model. Odds ratios with 95% confidence intervals were used to estimate the strength of association between the independent variables which are: 1) training of health workers with different nutrition packages, 2) availability of nutrition assessment equipment at varied service delivery points, 3) availability of nutrition supplies for preventing and treating acute malnutrition, 4) availability of nutrition treatment protocols and IEC materials functionality of quality improvement teams, and 5) supervision and motivation of health workers. The dependent variables were indicated by percentage of children and pregnant women who were provided with appropriate NACS in outpatient departments, young child clinics, antenatal clinics, postnatal clinics and antiretroviral therapy (ART) departments in the past 3 months. Statistical analysis was performed with IBM SPSS 25.0. All associations with p < 0.05 were considered statistically significant. All surveyed facilities offer maternal health services, a positive indication that a greater percentage of the facilities in western Uganda realize the importance of nutrition assessment of pregnant mothers and children. Of the sampled health facilities supported by SPRING Uganda, 56.3% had functional nutrition assessment equipment like mid-upper arm circumferences (MUAC) tapes and weighing scales. This study showed that different nutritional services offered to pregnant and lactating mothers and children could either positively or negatively affect the quality of nutrition in Ntungamo District.
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Muwonge, Adrian, Tone Johansen, Edvardsen Vigdis, Jacques Godfroid, Francisco Olea-Popelka, Demelash Biffa, Eystein Skjerve, and Berit Djonne. "Mycobacterium bovis infections in slaughter pigs in Mubende district, Uganda: a public health concern." BioMed Central, 2012. http://hdl.handle.net/10150/610107.
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BACKGROUND:Bovine tuberculosis (TB) caused by Mycobacterium bovis is primarily a disease of ruminants, particularly cattle (Bos primigenius) and buffalo (Syncerus caffer), and is endemic in most developing countries. To date, studies done in Uganda have documented the prevalence of M. bovis in cattle, humans and wild life, in addition to non-tuberculous mycobacteria in pigs. Pigs are increasingly becoming an important component of the livestock sector and share the human ecosystem in rural Uganda. It is therefore of public health interest that they are not a source of human infections. As a follow up to previously published findings on mycobacteria in pigs, this study was aimed at investigating the occurrence and molecular characteristics of M. bovis detected in slaughter pigs in Mubende district, Uganda. One hundred fifty mesenteric lymph nodes with lesions suggestive of mycobacterial infections were collected from approximately one thousand slaughtered pigs in Mubende district over a period of five months. The isolation and identification of M. bovis was done using conventional mycobacteriological methods. Mycobacteria belonging to the Mycobacterium tuberculosis complex (MTC) were identified to species level using deletion analysis. Molecular typing was done using Spoligotyping and MIRU-VNTR analysis. Molecular data were analysed and interpreted using MIRU-VNTR plus, SpolDB4.0 and the Mycobacterium bovis spoligo database.RESULTS:Of the examined animals, one boar and two sows from Madudu Sub County were infected with M. bovis which presented as lesions of a deep yellow colour and a grit-like texture in the mesenteric lymph nodes. This represents 2% (3/150) of the lymph nodes where lesions suggestive of mycobacterial infections were detected. Molecular analysis revealed that the isolates from the infected pigs showed identical MIRU-VNTR profile and spoligotype (SB1469).CONCLUSIONS:This is the first study documenting the occurrence of M. bovis in slaughter pigs in Uganda, revealing that one in fifty slaughter pigs with suspected lesions in mesenteric lymph nodes were infected. Molecular analysis revealed that the isolates were identical, showing a spoligotype previously reported from humans and cattle in the north eastern part of the Uganda cattle corridor. This finding is of public health importance, therefore there is a need for close cooperation between medical and veterinary professionals in designing and implementing control and prevention measures that safeguard the public from this potential source of zoonotic TB in Uganda.
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Swartz, Alison. "Community health workers in Khayelitsha : motivations and challenges as providers of care and players within the health system." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/12199.
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Community health workers (CHWs) play an important role in health care in South Africa and similar countries, but relatively little is known about CHW motivations and experiences in the provision of care. This thesis considers these issues in three parts: 1. A protocol for a study of community health work in Khayelitsha, an impoverished peri-urban settlement near Cape Town, which is home to a number of ‘flagship’ public health interventions aimed at HIV/AIDS and TB. 2. A review of literature on community health work exploring naturalistic versus economistic discourses around care work, and the complex intersections of these discourses. 3. An ethnographic account of CHWs who provide a wide range of community-based care work in Khayelitsha.
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Amani, Adidja. "The Health Workers Crises In Cameroon." Digital Archive @ GSU, 2010. http://digitalarchive.gsu.edu/iph_theses/139.
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The physician’s crisis in Cameroon has reached an alarming stage and has the potential to worsen existing health problems including the attainment of millennium development goals. This report emphasized the challenges faced by Cameroonian physicians, and recommended alternative solutions to the current government health workers policies. The report was done through a review of articles and documents covering the topic. At the center of the physician’s crises in Cameroon is the discrepancy between financial, social and professional expectations and what the government offers. The analysis showed that, there is a general dissatisfaction, despite some corrective measures implemented by the government. This suggests that the government needs to aggressively adopt and implement aggressive retention policies, such as improving the remuneration and working conditions of health workers. Beside, there is also need for innovation by adopting and implementing solutions that have been successful in others countries. As in many other countries, establishing powerful unions and lobbying groups by Cameroon physicians may help in negotiating acceptable working conditions that could help in alleviating the challenges of Cameroonian physicians. Despite some limitations, this report can be useful for policy-makers in the formulation of effective human resources for health policies but also to draw attention to the need to publish more on human resources for health issues in Cameroon.
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Olwit, Connie. "Stigma towards people with mental illness: a cross-sectional study among nursing staff in health facilities in Amolatar district, Uganda." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16709.
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Includes bibliographical referencesIntroduction: Mental health of Ugandans could be improved through mainstreaming the services into primary care systems. Nurses constitute a high percentage of the workforce in health; therefore they can significantly contribute towards several experiences by patients with mental illness. Stigma towards mental illness and individuals living with mental illness is among the major hindrances to effective mental health service delivery amongst healthcare workers. Therefore it is important for stigma to be explored among general nurses as mental health services are being integrated into the primary health care. The aim of this study was to explore stigma among general nurses towards mental illness and individuals living with mental illness. Methods: This was a cross-sectional quantitative study. Self-administered questionnaires were distributed to nurses working in Amolatar district health facilities that measured knowledge, attitudes and behaviour towards individuals living with mental illness, in addition to their familiarity with a person with mental illness. Descriptive statistics were used to determine the extent to which stigma was reported in this population. Bivariate and multivariate analyses were done using linear and logistic regressions to identify the predictors of the knowledge, attitudes and behaviours of nurses regarding mental illness and individuals living with mental illness. Results: Sixty-three general nurses participated in the study. Most of the participants identified schizophrenia as an SMI, however 79% considered stress to be mental illness and only a quarter of respondents scored above 80% on knowledge about mental illness. Most of the participants believed that psychotherapy was the most effective treatment for mental disorders. The nurses were benevolent (mean 3.06, s.d 0.29) and showed acceptance towards mental health services and individuals living with mental illness in the community (mean 3.56, s.d 0.30) however the nurses tended towards authoritarianism (mean 3.74, s.d 0.34) and social restrictiveness (mean 2.98, s.d 0.27). Level of contact with individuals living with mental illness predicted community mental health ideology and authoritarianism. No demographic variables were associated with level of knowledge using MAKS score and intended behaviour using RIBS tool. Conclusion: This study has provided some of the first data on stigma among primary health care nurses towards people with mental illness in Uganda and has added to knowledge of stigma towards people with mental illness by health care providers in LAMIC. Many of the findings were positive and bode well for the planned integration of mental health in primary health care. The negative findings of this study have shown that there are many areas for improvement which could be tackled by interventions such as public and community education, and in-service training regarding causes and management of mental disorders. Further research could be done to understand more about the negative attitudes found in many LAMIC.
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Moodley, Jennifer Rose. "Prevention of cervical cancer in South Africa : opportunities and challenges." Doctoral thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10990.
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Harries, Jane. "Abortion services in South Africa : challenges and barriers to safe abortion care : health care providers' perspectives." Doctoral thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/10623.
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Includes bibliographical references (leaves 199-213).Unsafe abortion is a preventable phenomenon and continues to be a major public health problem in many countries especially in the developing world. Despite abortion being legally available in South Africa after a change in legislation in 1996, barriers to accessing safe abortion services continue to exist. These barriers include provider opposition to abortion, and a shortage of trained and willing abortion providers. The dearth of abortion providers undermines the availability of safe, legal abortion, and has serious implications for women's access to abortion services and health service planning.
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Parisian, Esther Elizabeth. "Health Care Reform and Rural Hospitals: Opportunities and Challenges under the Affordable Care Act." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1313596532.
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Zanuzdana, Arina [Verfasser]. "Health in urban slums: Challenges and opportunities for public health research. Example of Dhaka, Bangladesh / Arina Zanuzdana." Bielefeld : Universitätsbibliothek Bielefeld, 2019. http://d-nb.info/1200097599/34.
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Stenlund, Linnea. ""We have to keep on improvsing" AN ETNOGRAPHIC FIELD STUDY ABOUT THE CHALLENGES AND STRATEGIES OF NURSES IN CENTRAL UGANDA." Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-27099.
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Syfte: Att undersöka vilka utmaningar sjuksköterskor möter i arbetet på ett sjukhus i centrala Uganda samt att undersöka vilka strategier de använder för att hantera dessa utmaningar. Bakgrund: I Uganda är medellivslängden 53 år och 50% av befolkningen är under 14 år. Det gör att sjukdomspanoramat ser annorlunda ut i jämförelse med europeiska länder. De vanligaste dödsorsakerna i Uganda är malaria, pneumoni och följdsjukdomar relaterat till HIV/AIDS. Den statliga finaniseringen av sjukvården är lägre än i andra subsahariska länder. Sjukhuset i Entebbe bör enligt rekommendationer från det Ugandiska Hälso Ministeriet ha 46 sjuksköterskor och 11 läkare men i dagsläget är antalet sjuksköterskor 17 och läkare 7 stycken. Metod: En etnografisk studie baserad på observationer av sjuksköterskor på sjukhuset i Entebbe i Uganda samt intervjuer med sjuksköterskor på samma sjukhus. Studien gjordes under fyra veckor, November – December 2014. Materialet analyserades med innehållsanalys. Resultat: Sjuksköterskorna upplevde att de största utmaningarna i deras arbete låg i brist på personal, otillräcklig utrustning och beroendet av anhöriga till patienter. De strategier som sjuksköterskorna använde var att improvisera, tron på Gud, att samlas varje vecka och att individuellt planera sina arbetspass. Slutsats: Sjuksköterskorna på sjukhuset i Entebbe mötte många olika utmaningar och använde olika strategier för att hantera dem. På grund av den kulturella och ekonomiska kontexten så skiljer sig både utmaningarna och strategierna från situationen i Sverige. Mer forskning är eftersträvansvärd för en fördjupad förståelse.Aim: To explore what kind of challenges nurses are facing in their work at a hospital incentral Uganda and what strategies they used due to these challenges. Background: In Uganda, life expectancy is 53 years old and 50% of the population is under 14 years. This means that the spectrum of diseases looks different in comparison from European countries. The most common causes of death are malaria, pneumonia and complications related to HIV and AIDS. State funding of health care is lower than in other sub-Saharan countries. The hospital in Entebbe should, as recommended by the Ugandan Ministry of Health, have 46 nurses and 11 doctors but in the present situation the number of nurses are 18 and 7 doctors.Method: An ethnographic study based on observations of the nurses at the hospital in Entebbe, Uganda and interviews with nurses at the same hospital. The study was done in four weeks from November to December 2014. The material was analysed using content analysis. Findings: The nurses experienced that the biggest challenges in their work was the shortage of staff, lack of equipment and dependence on relatives of patients. The strategies the nurses used were improvisation, faith in God, gathering every week and individually plan their shift. Conclusion: The nurses at Entebbe hospital faces a range of challenges and applies various kinds of strategies to deal with those. Due to the cultural and economic context both the challenges and strategies differs from the situation in Sweden. Further research should be done for a deeper understanding.
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Atuhaire, Lydia. "Barriers and facilitators to uptake of cervical cancer screening among women accessing maternal and child health services in Kampala, Uganda." University of Western Cape, 2013. http://hdl.handle.net/11394/3924.
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Magister Public Health - MPHThe aim of the study was to explore the challenges to uptake of cervical cancer screening among women accessing maternal and child health services at Nsambya Hospital in Kampala, Uganda.
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Henriksson, Dorcus Kiwanuka. "Health systems bottlenecks and evidence-based district health planning : Experiences from the district health system in Uganda." Doctoral thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-329082.
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In low-income countries where maternal and child mortality remains high, there is limited use of context-specific evidence for decision making and prioritization of interventions in the planning process at the sub-national level, such as the district level. Knowledge on the utility of tools and interventions to promote use of district-specific evidence in the planning process is limited, yet it could contribute to the prioritization of high-impact interventions for women and children. This thesis aims to investigate, in the planning process, the use of district-specific evidence to identify gaps in service delivery in the district health system in Uganda in order to contribute to improving health services for women and children. Study I evaluated the use of the modified Tanahashi model to identify bottlenecks for service delivery of maternal and newborn interventions. Study II and III used qualitative methods to document the experiences of district managers in adopting tools to facilitate the utilization of district-specific evidence, and the barriers and enablers to the use of these tools in the planning process. Study IV used qualitative methods, and analysis of district annual health work plans and reports. District managers were able to adopt tools for the utilization of district-specific evidence in the planning process. Governance and leadership were a major influence on the use of district-specific evidence. Limited decision space and fiscal space, and limited financial resources, and inadequate routine health information systems were also barriers to the utilization of district-specific evidence. Use of district-specific evidence in the planning process is not an end in itself but part of a process to improve the prioritization of interventions for women and children. In order to prioritize high impact interventions at the district level, a multifaceted approach needs to be taken that not only focuses on use of evidence, but also focuses on broader health system aspects like governance and leadership, the decision and fiscal space available to the district managers, limited resources, and inadequate routine health information systems.
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Wikström, Git. "Women’s Perspectives on Pathway to Diagnosis of Pulmonary Tuberculosis : Women Voices from Community Level in Uganda." Thesis, Nordic School of Public Health NHV, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-3116.
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Objectives: A qualitative study to explore the perceptions and ideas of women at community level in Uganda, about factors influencing their health care-seeking behaviour when symptoms that could indicate pulmonary tuberculosis. To let the women identify barriers to health care-seeking and to let them present ideas how to overcome barriers. Method: Focus Group Discussions (72 informants) and In Depth Interviews (19 informants) were conducted in rural Uganda with women of reproductive age. For triangulation purposes discussions and interviews also included health care providers, traditional healers and a few men. Main Results: The data showed a wide range of health care-seeking behaviours including no action at all, self-treatment using traditional herbs or western medicines, consulting traditional healers and consulting various formal or informal healthcare facilities. The data also identified many barriers that could prevent women from getting a proper diagnosis, including lack of financial resources, lack of power, male supremacy in decision-making, lack of knowledge, perceived corruption in healthcare facilities, fear of stigma and this fear heavily boosted by the idea that PTB equates HIV/AIDS. Conclusion: These data support the idea that successfully fighting PTB among Ugandan women and increasing case finding, demands recognition that tuberculosis is a multifaceted disease: economical, social, psychological and medical. Therefore, approaches to eradicating tuberculosis must target different sectors and reach all levels of societyISBN 978-91-86739-19-5
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SSERWANJA, QURAISH. "Socio-economic determinants of undernutrition among women of reproductive age in Uganda: a secondary analysis of the 2016 Uganda demographic health survey." Thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-396316.
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Background Nutrition is a fundamental pillar of human life. Women have an increased risk of undernutrition than men. Undernutrition can result in adverse pregnancy outcomes and intergeneration cycle of undernutrition. The aim of this study is to determine the prevalence of undernutrition and the associated socio-economic determinants among adult women of reproductive age in Uganda. Methods A population based cross-sectional survey was conducted and 4,640 non-pregnant and non-post-partum women aged 20 to 49 were analyzed. Two stage stratified sampling was used to select study participants and data were collected using validated questionnaires. Multivariable logistic regression was used to model the association between socio-economic determinants and stunting and underweight using weighted data in SPSS version 24. Results The prevalence of underweight and stunting were 6.9% and 1.3% respectively. Women who belonged to middle (aOR = 2.49, 95% CI 1.25-4.99), poorer (aOR = 3.07, 95%CI 1.57–5.97) and poorest wealth index (aOR = 3.60, 95% CI 1.85–7.00) were more likely to be underweight compared to the richest. Belonging to rural residence (aOR = 0.63, 95%CI 0.41–0.96), Western (aOR = 0.30, 95% CI 0.20–0.44), Eastern (aOR = 0.42, 95% CI 0.28–0.63) and Central regions (aOR = 0.42, 95% CI 0.25–0.72) was associated with less odds of being underweight. Region was the only variable significantly associated with stunting. Wealth index was not significantly associated with stunting. Conclusion The prevalence of undernutrition in Uganda among women is less compared to most of the neighboring countries. There is need to address the socio-economic determinants including poverty, residence and reducing regional inequalities.
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Meit, Michael, and Kate E. Beatty. "Leveraging Assets to Improve Rural Health and Equity: Challenges and Opportunities." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6839.
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Kiwanuka, Julie. "Is contracting out an efficient means of delivering health support services? : a case study of a public hospital in Uganda." Master's thesis, University of Cape Town, 2001. http://hdl.handle.net/11427/8762.
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Bibliography: leaves 96-99.Health reforms that advocate for more private sector involvement in the provision and financing of health services are increasingly being considered as a means of ensuring more efficient provision of health related services. Though such reforms may be designed, funded and implemented it does not imply that the conditions necessary for them to yield the intended results do exist. One such reform is contracting out. The only national referral hospital Uganda has a long history of contracting out health support services, but there is hardly any empirical evidence of the resultant efficiency gains. To study the contractual arrangements in the hospital a theoretical framework based on what determines contract performance was used as the basis for the analysis. Several methodology approaches were used, which included in-depth structured interviews with the hospital administrator and key government officials on the entire contractual process and to establish the regulations and policies underlying the contracting out policy in the country. In addition a detailed documentary review was done for the contract design and implementation and other issues pertaining to the cleaning and security services. Cost data was obtained from the hospital’s expenditure and accounts records. Quality of the services data was collected using a quantitative interview schedule that required consumers to indicate their satisfaction with the security and cleaning services when they are provided in-house as opposed to when they are provided by contractors. One of the major findings is that while it was cheaper to provide cleaning services through contracting out, it was actually more costly to provide security services through contracting out than in-house provision. Therefore there is no clear pattern to support the hypothesis that health support services can be provided at a lower cost than direct provision of services. This is because contract costs are a function of service complexity, contestability and management capacity. Services that are hard to specify involve uncertainty about the nature and costs of production itself, which is likely to increase total contract costs both during contract negotiations and the post contract stage. Secondly, contractors had succeeded in providing better quality services than in-house provision. One pertinent issue of contract design is that is key to contract success is the detailed specifications of the expected outcome in terms of both quantity and quality for this greatly eases the enforcement and monitoring process and is likely to a positive impact on the quality of services that the contractors provide, for both parties will have a clear picture of what was expected. The study highlights a number of factors that contribute to the success of contracts: First, governments needs cost and quality information on its own services for this should be the basis upon which decisions to contract out should be made. Secondly, award and renewal of contracts requires regular and detailed evaluation of provider performance and of the market situation especially in low contestability and competition. Thirdly, there is need to have incentives within the management of contracts efficient monitoring. Lastly, contract failure was attributed more to the government bureaucratic and centralised systems that often resulted in delays in awarding contracts and paying contractors.
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Nalukenge, Winifred. "A qualitative study of mental health explanatory models, and the perceived impact of life experiences on mental health, in HIV infected adolescents in rural and urban Uganda." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27472.
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Background: Survival of children and adolescents with HIV/AIDS has greatly improved with antiretroviral treatment. These young people now live with a chronic, rather than a fatal disease, which has brought into focus issues of quality of life, including the emotional and behavioral wellbeing of those living with the disease. HIV infection is associated with poor mental health and a high prevalence of behavioral and emotional problems in affected adolescents. Despite this burden of emotional and behavioral problems, the majority of HIV care services in sub-Saharan Africa do not have mental health care services specifically targeting adolescents with HIV. In order to address mental health in this population, it is important to explore their explanatory models to understand aspects such as how they view their symptoms, and what treatment or support they prefer. At the present time, research is scarce regarding explanatory models of mental disorders in HIV-positive adolescents and no study has been conducted in Uganda. This study aimed to address this gap by exploring the explanatory models of mental disorders and perceived daily life challenges in HIV-infected adolescents who had been diagnosed with a common mental disorder. Methods: This qualitative study was nested in a longitudinal epidemiological study that investigated prevalence, incidence and risk factors for mental health problems in HIV-infected children and adolescents in rural and urban Uganda. In-depth interviews were conducted with adolescents aged 12 to 17 years who had been diagnosed with depression, anxiety or attention deficit hyperactivity disorder (ADHD). Case vignettes were used to enable adolescents to talk about their experiences and daily life challenges. Written consent and assent were sought from caregivers and adolescents respectively. Data were processed and analyzed thematically. NVivo-11 was used to manage data for analysis. Results: Twenty-one adolescents participated in the study. Most adolescents (9/21) in the study were living with their grandparents. Twelve were in primary school and 4 had dropped out. The main findings were: (i) the adolescents had not been informed about their mental disorder diagnoses and none viewed their symptoms as illness, (ii) they attributed their symptoms to daily life problems, such as poverty and interpersonal relationship problems, and did not mention biomedical or spiritual causes, (iii) they thought that their symptoms would improve with time, and financial and emotional support were also important. Conclusion: The findings of this study highlight the need for action at the mental health policy and practice levels. The main areas for such intervention include mental health literacy, screening and intervention in healthcare settings, and psychosocial interventions in community and school settings for affected adolescents and their caregivers.
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Hartzell, Michele Spurgeon. "Obesity challenges and benefits of implementing local wellness policies in Georgia public schools /." Click here to access dissertation, 2008. http://www.georgiasouthern.edu/etd/archive/spring2008/michele_s_hartzell/hartzell_michele_s_200801_EDD.pdf.
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Thesis (Ed.D.)--Georgia Southern University, 2008."A dissertation submitted to the Graduate Faculty of Georgia Southern University in partial fulfillment of the requirements for the degree Doctor of Education." Under the direction of Charles A. Reavis. ETD. Electronic version approved: May 2008. Includes bibliographical references (p. 109-113) and appendices.
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Briggle, Leslie. "Veterans' perceptions of reintegration challenges and their most valuable social supports." Honors in the Major Thesis, University of Central Florida, 2013. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/827.
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With an increasing number of veterans returning to civilian life after deployment in combat, it is important to analyze what challenges they face during reintegration, what resources assist them with coping with these challenges, and which of these resources they perceive as the most helpful. The literature indicates that the most common challenges faced by returning veterans are employment difficulties, family readjustment problems and mental health issues which are shown to be positively affected by the presence of social support networks (Burnell, Coleman, & Hunt, 2009). There exists a gap, however in the research regarding the extent to which each particular social support network affects veterans' reintegration. This qualitative study explored veterans' perceptions of the challenges faced during reintegration, and the social supports which assisted the most during the reintegration process in order to try to bridge the gap in the research. The findings indicate that veterans struggle the most with reconnecting emotionally with family and friends, managing strong emotions (such as anxiety and alienation), missing the military after discharge, and dealing with the negative effects of deployment on daily life (such as difficulty sleeping, anxiety, and difficulty finding employment). Unit support was overwhelmingly expressed as the most helpful social support, while family and friends were seen more as a challenge than a help. Many veterans went on to surround themselves with fellow veterans and/or join the reserves after their active duty was up.B.S.W.
Bachelors
Health and Public Affairs
Social Work
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Cai, Beilei 1979. "Essays in health and environmental economics: Challenges in the empirical analysis of micro-level economic survey data." Thesis, University of Oregon, 2008. http://hdl.handle.net/1794/8505.
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xi, 108 p. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number.Micro-level survey data are widely used in applied economic research. This dissertation, which consists of three empirical papers, demonstrates challenges in empirical research using micro-level survey data, as well as some methods to accommodate these problems. Chapter II examines the effect of China's recent public health insurance reform on health utilization and health status. Chinese policy makers have been eager to identify how this reform, characterized by a substantial increase in out-of-pocket costs, has affected health care demand and health status. However, due to self-selection of individuals into the publicly insured group, the impact of the reform remains an unresolved issue. I employ a Heckman selection model in the context of difference-in-difference regression to accommodate the selection problem, and provide the first solid empirical evidence that the recent public health insurance reforms in China adversely affected both health care access and health status for publicly insured individuals. Chapter III examines the construct validity of a stated preference (SP) survey concerning climate change policy. Due to the fact that the SP survey method remains a controversial tool for benefit-cost analysis, every part of the survey deserves thorough examination to ensure the quality of the data. Using a random utility approach, I establish that there is a great deal of logical consistency between people's professed attitudes toward different payment vehicles and their subsequent choices among policies which vary in the incidence of their costs. Chapter IV employs the same survey data used in Chapter III, but demonstrates the potential for order effects stemming from prior attitude-elicitation questions. In addition, it considers the potential impact of these order effects on Willingness to Pay (WTP) estimates for climate change mitigation. I find the orderings of prior elicitation questions may change people's opinions toward various attributes of the different policies, and thereby increase or decrease their WTP by a substantial amount. Thus, this chapter emphasizes the significance of order effects in prior elicitation questions, and supports a call for diligence in using randomly ordered prior elicitation questions in stated preference surveys, to minimize inadvertent effects from any single arbitrary ordering.
Adviser: Trudy Ann Cameron
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Perkins, Jessica M. "Conducting Social Network and Social Norm Research in Low-Resource Settings: Food Insecurity, Depression, and HIV Testing in Rural Uganda." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17467207.
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This dissertation examines the role of social networks and social norms in health outcomes and behaviors among low-and middle-income countries (LMICs), with a particular focus on Uganda. Paper 1 presents a systematic review of sociocentric network studies conducted in LMICs on health-related outcomes and other development topics. I first discuss the sociocentric network study designs employed in 36 selected papers, and provide a catalog of 105 name generator questions used to measure social ties. Second, I show that network composition, individual network centrality, and network structure are associated with health behaviors and health and development outcomes in different contexts across multiple levels of analysis and across distinct network types. Lastly, I highlight opportunities for health researchers and practitioners in LMICs to 1) design effective studies and interventions that account for the sociocentric network positions of certain individuals and overall network structure, 2) measure the spread of outcomes or intervention externalities, and 3) enhance the effectiveness and efficiency of aid based on knowledge of social structure.
Papers 2 and 3 exploit a population-based dataset on eight villages from rural Southwest Uganda, arising from a pilot study which myself and colleagues designed to collect sociocentric network data. There were a total of 1,669 adults interviewed representing a response rate of 96%. Paper 2 assesses the relationship between food insecurity and depression symptom severity in the general adult population, and the potential confounding or moderating roles of social network position, structure, and composition in that relationship. I find that severe and moderate food insecurity was associated with greater depression symptom severity among both men and women, and that none of the social network characteristics were directly associated with the outcome. Moreover, there were no interactions between food insecurity and network characteristics among women. For severely food insecure men, however, personal network centrality was positively associated with symptoms and personal network poverty composition was negatively associated with symptoms. Findings reveal that nutrition interventions aimed at improving food security in rural areas may have significant beneficial effects in terms of mental health outcomes for the whole population. I discuss the possible role of shame in affecting depression among severely food insecure men with wealthier networks and in more central network locations.
Paper 3 examines the extent to which individuals underestimate the prevalence of HIV testing in their village and misperceive the norm, and also assesses the relationship between perception of the HIV testing norm in one’s village with personally never having been tested. I find that although a majority of people had been tested in each of the villages, a majority of people underestimated the actual prevalence and thought that testing was not normative. Men who perceived testing as not normative were much more likely to never have been tested, and both men and women who felt they didn’t know anything about the norm were also more likely to never have been tested. Results suggest that interventions promoting true HIV testing norms may help increase uptake of testing.Health Policy
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Selby, Richard James. "Limiting the northerly advance of Trypanosoma brucei rhodesiense in post conflict Uganda." Thesis, University of Edinburgh, 2011. http://hdl.handle.net/1842/5697.
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In October 2006 an intervention was initiated to arrest the northerly advance through Uganda of the zoonotic parasite Trypanosoma brucei rhodesiense. This is a protozoal infection that is vectored by the tsetse fly. It is the aim of this thesis to review the impact of this large scale treatment programme in terms of animal health and human disease. The Stamp Out Sleeping Sickness (SOS) campaign was designed to target the cattle reservoir of T. b. rhodesiense in these newly affected areas by block treating >180,000 head of cattle. This was achieved in collaboration with final year vet students from the University of Makerere, Uganda. Farmers were also encouraged to spray their animals with deltamethrin in order to suppress the tsetse population. In order to monitor the impact of this intervention a base line survey was carried out. Evaluation of the logistics and implementation of the SOS campaign was assessed through interviews with personnel involved. Analysis by PCR revealed the prevalence of T. brucei s.l. as 15.57% (T. b. rhodesiense as 0.81%) within the cattle reservoir prior to SOS treatment. Follow up sampling was carried out at 23 locations at three, nine and 18 months. The prevalence of T. brucei s.l. was reduced post treatment, but in the absence of sustained vector control infections amongst the animals returned by nine months and subsequently exceeded the base line findings (P=<0.0001). It was observed that across most of the SOS area, T. b. rhodesiense did not re-establish following treatment. However, a significant cluster was identified where cases of both human and animal disease were continually reported. This cluster was noted to include the area immediately surrounding the Otuboi cattle market. This link between cattle movement and the spread of T. b. rhodesiense is an established one and is addressed by Ugandan governmental policy which states that ‘cattle traded at market must be treated with trypanocidal drugs prior to movement’. The findings presented here suggest that this policy may not be strictly enforced. The risk of spread is compounded at the northern districts of Uganda restock their domestic livestock following years of civil conflict. The majority of animals are traded in a northward direction – transporting infected animals from the endemic south. The scale of this trade is assessed through questionnaires, analysis of trade records and animal screening. Specific consideration is given to the implications of this cattle trade and impact this may have on the sustainability of the SOS campaign.
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Mathekgane, Justice Mpho. "The laws regulating National Health Insurance scheme :prospects and challenges." Thesis, University of Limpopo, 2013. http://hdl.handle.net/10386/2542.
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Babikako, Harriet Mupere. "PATIENT PREFERENCES, STRUCTURE, AND HIV ARE ASSOCIATED WITH ADHERENCE TO TUBERCULOSIS TREATMENT IN URBAN UGANDA." Case Western Reserve University School of Graduate Studies / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=case1365180107.
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Hagen, Jerome D. "Interagency collaboration challenges among homeland security disciplines in urban areas." Thesis, Monterey, Calif. : Springfield, Va. : Naval Postgraduate School ; Available from National Technical Information Service, 2006. http://library.nps.navy.mil/uhtbin/hyperion/06Mar%5FHagen.pdf.
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Thesis (M.A. in Security Studies (Homeland Security and Defense))--Naval Postgraduate School, March 2006.Thesis Advisor(s): Jeff Knopf. "March 2006." Includes bibliographical references (p. 121-128). Also available online.
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Bjerneld, Magdalena. "Images, Motives, and Challenges for Western Health Workers in Humanitarian Aid." Doctoral thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-100891.
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This thesis presents how humanitarian aid workers were attracted, motivated, recruited, and prepared for fieldwork, and how they reported their work experience directly from the field and when they returned home. Data were derived from interviews with experienced aid workers, focus group discussions with presumptive aid workers, analysis of letters from aid workers in the field on MSFs homepages in Europe, and from interviews with recruitment officers at some of the main humanitarian organisations. Health professionals were attracted by the positive images of humanitarian action. They wished to work in teams with like-minded people, and to make a difference in the world. However, this image was not supported by the recruitment officers, or experienced aid workers, who described a complex reality in humanitarian action. The experienced aid workers instead had realised they learned more than they contributed. The recruitment system for relief workers would benefit from a more holistic approach, where personalities of the aid workers are more in focus. More time must be spent with the applicants, both recruited and returning aid workers, in order to improve the system. A socialisation approach could help identify the right personnel and to motivate current personnel to continue.
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Nanyunja, Miriam. "Risk Factors for Measles among HIV-infected Children in Uganda." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2500.
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Measles remains a major global public health problem. Attainment of high population immunity to measles through vaccination is necessary to control this disease. Children infected with HIV infection often experience secondary measles vaccine failure by 2 years of age, making them susceptible to measles. It is not clear whether HIV-infected children on Highly Active Antiretroviral Treatment (HAART), older than 2 years, have a higher risk of measles than HIV-uninfected children. This retrospective cohort study, guided by the proximate determinants framework, was conducted to compare the risk of measles between HIV-infected children on HAART (exposed) and HIV-uninfected peers (unexposed). The age group with the highest measles susceptibility in the exposed children, which could inform timing for revaccination, was investigated. The role of age at initiation of HAART, low CD4+ count, and undernutrition as predictors of the risk of measles in the exposed children was examined. Univariate, bivariate, and binomial logistic regression analytical procedures were used in data analysis. Results showed no significant difference in the risk of measles between exposed and unexposed children. The age groups 5 to 9 years and 2 to 4 years were the first and second most affected by measles among the exposed children. Undernutrition (stunting) was a significant predictor of measles in exposed children (odds ratio of 4.14, p = 0.02), while age at initiation of HAART and CD4+ count prior to measles exposure were not. The study findings provide evidence to inform vaccination policy and nutrition care for HIV-infected children on HAART in Uganda, so as to reduce their risk of measles illness and mortality, thus contributing to positive social change for the children and the country.
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Salih, Harith Mohammed Saleem. "Brucellosis in Iraq: epidemiology, present status, and challenges in controlling the disease." Thesis, Kansas State University, 2010. http://hdl.handle.net/2097/6240.
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Master of ScienceDepartment of Diagnostic Medicine/Pathobiology
Gary A. Anderson
Brucellosis is one of the major endemic zoonotic diseases worldwide, and it has history dating back to 1937 in Iraq when it was first isolated by an Iraqi physician. In order to establish a solution for the continuous devastating impacts of the disease in humans and livestock, the Brucellosis Control Program was established in 1995. The main responsibilities of this program were setting and implementing the appropriate strategies for controlling the disease. After the war in 2003, the United Nation organization for Food and Agriculture (FAO) developed a strategic plan to control the disease. The main goal of the project was to improve productivity in the livestock sector and reduce the prevalence of disease in small ruminants (sheep and goats) to less than 2%, and less than 0.2% in cattle and buffalo. Achieving such goals ultimately would reduce the disease incidence among the human population from more than 27.2 cases/100,000 persons in 2002, to less than 4 cases/100,000 people within 15 years. A serological surveillance was conducted and revealed the apparent prevalence of the disease in sheep and goats, cattle, buffalo, and camels was 6.51%, 1%, 1.48%, and 0.02%, respectively in Iraqi governorates except the three northern governorates of Kurdistan province . Based on surveillance results, a vaccination policy was the only appropriate strategy that could be chosen to control the disease. Four vaccination campaigns were implemented in 2006, 2007, 2008, and 2009, with a total number of vaccinated animals each year at 10099972, 4698482, 753153, and 1833482 head, respectively. The primary satisfactory outcome of the program was the apparent decline in livestock abortions leading to obvious increases in productivity. Regarding the incidence of brucellosis among the human population, the apparent decline in the middle and south of Iraq began with the vaccination phase of the control program in 2006. The results represented a significant decrease in human cases after only four vaccination campaigns of a program that was intended to continue for 15 years.
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Lindhe, Söderlund Lena. "Challenges of learning and practicing motivational interviewing." Licentiate thesis, Linköping University, Linköping University, Division of Preventive and Social Medicine and Public Health Science, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-17351.
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Background: The past three decades have seen a growth in health promotion research and practice, stimulated by the epidemiologic transition of the leading causes of death from infectious to chronic diseases. An estimated 50% of mortality from the 10 leading causes of death is due to behaviour, which suggests individuals can make important contributions to their own health by adopting some health-related behaviours and avoiding others. Motivational interviewing (MI) has emerged as a brief counselling approach for behavioural modification that builds on a patient empowerment perspective by supporting self-esteem and self-efficacy. MI has become increasingly popular in a variety of health care settings as well as non-health care settings.
Aims: The overall aim of this thesis is to contribute to improved understanding of the different factors that impact on the learning and practice of MI. The aim of study I was to identify barriers and facilitators to use MI with overweight and obese children in child welfare and school health services. The aim of study II was to identify barriers, facilitators and modifiers to use MI with pharmacy clients in community pharmacies.
Methods: Participants in study I were five child welfare centre nurses from the county council and six municipally-employed school health service nurses, all from Östergötland, Sweden. Participants in study II were 15 community pharmacy pharmacists in Östergötland Sweden. Data for both studies were obtained through focus group interviews with the participants, using interview guides containing open-ended questions related to the aims of the studies. Study II also included five individual interviews. Interview data were interpreted from a phenomenological perspective.
Results: In study I, important barriers were nurses’ lack of recognition that overweight and obesity among children constitutes a health problem, problem ambivalence among nurses who felt that children’s weight might be a problem although there was no immediate motivation to do anything, and parents who the nurses believed were unmotivated to deal with their children’s weight problem. Facilitators included nurses’ recognition of the advantages of MI, parents who were cooperative and aware of the health problem, and working with obese children rather than those who were overweight. In study II, pharmacists who had previously participated in education that included elements similar to MI felt this facilitated their use of MI. The opportunity to decide on appropriate clients and/or healthrelated behaviours for counselling was also an important facilitator. The pharmacists believed the physical environment of the pharmacies was favourable for MI use, but they experienced time limitations when there were many clients on the premises. They also experienced many difficulties associated with the practical application of MI, including initiating and concluding client conversations.
Conclusions: Learning and practicing MI effectively is difficult for many practitioners as it requires a new way of thinking and acting. Practitioners’ use of MI is not effective unless there is recognition that there is an important health-related problem to be solved. Practitioners feel more confident using MI with clients who have health-compromising behaviours and/or risks in which the practitioners feel they have expertise. Possessing considerable MI counselling skills does not compensate for insufficient knowledge about a targeted health-related behaviour and/or risk. Feedback from clients plays an important role for the quality and quantity of practitioners’ MI use.
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Schaepe, Christiane. "And here we are allowed to do it - An ethnographic field study about the role of the palliative care nurses in Uganda." Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-24457.
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Palliativ vård – vård i livets slutskede – är inte prioriterat i tredje världen. I Uganda grundades 1993 Hospice Africa Uganda (HAU), ett hospice som var tänkt som modell för andra afrikanska länder. Här utbildas bl a sjuksköterskor som har rätt att skriva ut morfin och andra läkemedel efter en nio månader lång kurs. I den här etnografiska fältstudien används observationer, intervjuer och gruppintervjuer för att undersöka sjuksköterskan roll inom palliativ vård i Uganda. I studien deltar sammanlagt 20 sjuksköterskor som jobbar på HAU, Mulago hospital och studenter i palliativ vård-kursen på HAU. Resultatet visar att sjuksköterskanS roll är mångfacetterad. Utöver förskrivning av läkemedel är deras roll att utföra vården holistisk, där de tar hänsyn till fysisk, psykosocial och andlig smärta. I sitt arbete möter de många utmaningar men de har även möjlighet att förbättra patientens livskvalitet.Palliative care – end of life care – is not a priority in developing countries. In 1993 Hospice Africa Uganda (HAU) was founded and chosen as a model for other african counties. Among other things nurses are authorised to prescribe morphine and other palliative care drugs after undergoing a nine months clinical palliative care course at HAU. In this ethnographic field study observations, interviews and group interviews are used in order to explore the role of the palliative care nurse specialist in Uganda. In total there are 20 participants involved in this study, who are working at HAU, Mulago hospital and students from the clinical palliative care course. The result of the study reveal that the role of the palliative care nurse specialist is multifaceted. Beyond prescribing drugs their role is to deliver holistic care by taking into consideration the physical, psychosocial and spiritual pain patients and their family can have. They encounter many challenges in their work but they also have the possibility to improve the quality of the patients life.
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Rösel, Kristina [Verfasser]. "Assessment of the parasitic burden in the smallholder pig value chain and implications for public health in Uganda / Kristina Rösel." Berlin : Freie Universität Berlin, 2018. http://d-nb.info/1150704578/34.
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Tayob, Shamima. "Challenges in the management of drug supply in public health centres in the Sedibeng District, Gauteng Province." Thesis, University of Limpopo (Medunsa Campus), 2012. http://hdl.handle.net/10386/683.
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Thesis (MSc(Med)(Pharmacy))--University of Limpopo, 2012.ABSTRACT South Africa, 80% of the population is dependent on the vernment to provide for their health care needs, mainly ugh primary health care facilities. In the health objectives of the National Drug Policy, the government of South Africa outlines its commitment to ensuring availability and accessibility of medicines which are effective, affordable, safe and of good quality in all sectors of the health care system ( N a t ion a IDe par t men t of He a It h, 1 996) . In o rd e r to assess the availability of d ru g s and identify ch a II en g e s w hi c h . ex is tin the Emf u Ie n i sub - d is t r i c t wi t hi nth e Sedibeng district, a questionnaire was administered to 21 primary health care facility managers/store managers, fo u r Community Health Centre managers and five transport officers in the district. In addition, a document review process was conducted to verify aspects of th e facility managers' and store managers' responses. Bin cards and primary health care order files were also examined in conjunction with a checklist to establish whether stock control systems were in place. There was a 100% response with all primary health care centres and community health care centres completing th e questionnaires. It was established that drugs at primary and community health care clinics were procured from the Sedibeng district pharmacy. In each of these clin ics there were specific individuals responsible for medicine supply management. Only four primary health care clinics had full-time pharmacist assistants employed, and 14 clinics were visited by the assistants on a weekly/bi-weekly basis. There were no employees that have received training in drug supply management in the last 12 months in 88% of the clinics interviewed. Nineteen clinics claimed that the storage area was not large e n 0 ugh to s tor e a II the s toe k f or a m 0 nth's sup ply and 0 n I yon e clinic had a secure delivery area for their medication. It was established that 24 facilities received stock by two specific procedures namely; that the number of boxes were checked and the driver's note was then signed, and stock received was checked against the invoice. Of the interviewed cl i nics, 20% admitted that the re-order level had not been calculated for all tracer items in the store. Standard Operating Procedures, Standard Treatment Guidelines and the Essential Drugs List were also not available at all facilities. The results indicate inadequacies and weaknesses in procurement, quantification, stock control, storage and record keeping. It clearly demonstrates that inadequately-trained staff was a ma j 0 reo n t rib uti n g fa c tor to d rug s h 0 r tag e s. The r e was a I a c k 0 f monitoring and evaluation by th e district pharmacy as pharmacists did not manage to visit all the clinics each month. Most of the inadequacies and weaknesses can be addressed at facility level with pro per supervision, in-service training, mentoring and support of staff and the reinforcement of drug supply management training. Regular supervisory visits together with updating the monitoring too I in terms of th e problems identified will improve th e management of drugs and ultimately decrease the number of out of stocks where problems have been identified at primary health care level.