BackgroundDrowning is a major cause of unintentional injury death worldwide. The toll is greatest... more BackgroundDrowning is a major cause of unintentional injury death worldwide. The toll is greatest in low and middle-income countries. Over 95% of people who drowned while boating in Uganda were not wearing a lifejacket. We explored the determinants of lifejacket use among boaters on Lake Albert, Uganda.MethodsWe conducted a qualitative enquiry with a hermeneutic phenomenological undertone leaning on relativism ontology and emic subjectivism epistemology. Focus group discussions (FGDs) and in-depth interviews (IDIs) were held with boaters in 10 landing sites. We explored experiences and perspectives on lifejacket use. We used thematic analysis technique to analyse data and report results according to the Consolidated Criteria for Reporting Qualitative Research.ResultsWe recruited 88 boaters in 10 FGDs and 11 to take part in the IDIs. We identified three themes: motivators and opportunities for lifejacket use, barriers and threats to lifejacket use, and strategies to improve lifejacke...
Background: Teso sub-region of Eastern Uganda had superior indices of childhood survival during t... more Background: Teso sub-region of Eastern Uganda had superior indices of childhood survival during the period 1959 to 1969 compared to the national average. We analysed the reasons that could explain this situation with a view of suggesting strategies for reducing childhood mortality. Methods: We compared the childhood mortalities and their average annual reduction rate (AARR) of Teso subregion with those of Uganda for the period 1959 to 1969. We also compared indicators of social economic well being (such as livestock per capita and per capita intake of protein/energy). In addition data was compared on other important determinants of child survival such as level of education and rate of urbanisation. Findings: In 1969 the infant mortality rate (IMR) for Teso was 94 per 1000 live births compared to the 120 for
PURPOSE Tobacco use is the leading cause of premature death worldwide. One aspect of tobacco cont... more PURPOSE Tobacco use is the leading cause of premature death worldwide. One aspect of tobacco control is convincing farmers to stop tobacco production. We assessed the willingness of tobacco farmers in Uganda to stop growing tobacco. METHODS We conducted a cross-sectional interview survey with an interviewer-administered questionnaire. Participants were active tobacco farmers in 12 villages of Kanungu district (N = 528) and were interviewed in 2013 to assess their willingness to stop growing tobacco. RESULTS Most farmers (61.7%) grew tobacco only as a cash crop with no supplemental income. A total of 198 farmers (37.5%) were willing to stop growing tobacco. Ninety-two respondents cited coffee as a potential replacement crop for tobacco and 106 mentioned rice. Barriers to growing replacement crops were that tobacco is highly profitable (n = 172) and that the soil (n = 175) and/or weather (n = 22) cannot sustain any crops other than tobacco. Willingness to stop growing tobacco was 1.32...
Background: Access to HIV testing and subsequent care among health care workers (HCWs) form a cri... more Background: Access to HIV testing and subsequent care among health care workers (HCWs) form a critical component of TB infection control measures for HCWs. Challenges to and gaps in access to HIV services among HCWs may thus compromise TB infection control. This study assessed HCWs HIV and TB screening uptake and explored their preferences for provision of HIV and TB care. Methods: A cross-sectional mixed-methods study involving 499 HCWs and 8 focus group discussions was conducted in Mukono and Wakiso districts in Uganda between October 2010 and February 2011. Results: Overall, 5% of the HCWs reported a history of TB in the past five years. None reported routine screening for TB disease or infection, although 89% were willing to participate in a TB screening program, 77% at the workplace. By contrast, 95% had previously tested for HIV; 34% outside their workplace, and 27% self-tested. Nearly half (45%) would prefer to receive HIV care outside their workplace. Hypothetical willingness to disclose HIV positive status to supervisors was moderate (63%) compared to willingness to disclose to sexual partners (94%). Older workers were more willing to disclose to a supervisor (adjusted prevalence ratio [APR] = 1.51, CI = 1.16-1.95). Being female (APR = 0.78, CI = 0.68-0.91), and working in the private sector (APR = 0.81, CI = 0.65-1.00) were independent predictors of unwillingness to disclose a positive HIV status to a supervisor. HCWs preferred having integrated occupational services, versus stand-alone HIV care. Conclusions: Discomfort with disclosure of HIV status to supervisors suggests that universal TB infection control measures that benefit all HCWs are more feasible than distinctions by HIVstatus, particularly for women, private sector, and younger HCWs. However, interventions to reduce stigma and ensuring confidentiality are also essential to ensure uptake of comprehensive HIV care including Isoniazid Preventive Therapy among HCWs.
Disclosure of HIV positive sero-status to sexual partners, friends or relatives is useful for pre... more Disclosure of HIV positive sero-status to sexual partners, friends or relatives is useful for prevention and care. Identifying factors associated with disclosure is a research priority as a high proportion of persons living with HIV/AIDS (PHA) never disclose. To identify factors associated with disclosure among PHAs in Mityana district of Uganda. Using a case control design, we compared 139 PHAs who had disclosed to 139 PHA who had not disclosed regarding socio demographic characteristics, sexual behaviour, individual experiences and perceptions about disclosure, as well as on health facility/community correlates of disclosure. The independent factors that favour disclosure are not fearing negative outcomes of disclosure adjusted odds ratio (AOR) 7.00, 95 % confidence interval (95% CI) 3.03-16.95, having communication skills to disclose (AOR 12.08, 95% CI 4.94-29.51), having initiated anti-retroviral therapy (AOR 7.51, 95% CI 3.42-16.49), not having tested for HIV during ante-natal ...
Background: Prevention and control of hypertension are critical in reducing morbidity and mortali... more Background: Prevention and control of hypertension are critical in reducing morbidity and mortality attributable to cardiovascular diseases. Awareness of hypertension is a pre-condition for control and prevention. This study estimated the proportion of adults who were hypertensive, were aware of their hypertension and those that achieved adequate control. Methods: We conducted a community based cross sectional survey among people$15 years in Buikwe and Mukono districts of Uganda. People had their blood pressure measured and were interviewed about their social-demographic characteristics. Hypertension was defined as systolic blood pressure $140 mmHg, or diastolic blood pressure $90 mmHg, or previous diagnosis of hypertension. Participants were classified as hypertensive aware if they reported that they had previously been informed by a health professional that they had hypertension. Control of hypertension among those aware was if systolic blood pressure was,140 mmHg and diastolic bl...
Background: A large, district-wide, home-based HIV counselling and testing (HBHCT) programme was ... more Background: A large, district-wide, home-based HIV counselling and testing (HBHCT) programme was implemented in Bushenyi district of Uganda from 2004 to 2007. This programme provided free HBHCT services to all consenting adults of Bushenyi district and had a very high uptake and acceptability. We measured population-level changes in knowledge of HIV status, stigma and HIV-risk behaviours before and after HBHCT to assess whether widespread HBHCT had an effect on trends of risky sexual behaviours and on stigma and discrimination towards HIV. Methods: Serial cross-sectional surveys were carried out before and after the implementation of HBHCT programme in Bushenyi district of Uganda. A total of 1402 randomly selected adults (18 to 49 years) were interviewed in the baseline survey. After the implementation, a different set of randomly selected 1562 adults was interviewed using the same questionnaire. Data was collected on socio-demographic characteristics, sexual behaviour, whether resp...
Study aim – the explicit study aim is not consistent with the outcomes, which suggest that the st... more Study aim – the explicit study aim is not consistent with the outcomes, which suggest that the study aim was to assess implementation of TB IC practices. This needs to be clarified. This comment is well taken. We now state “The study aim was to assess implementation of TBIC practices and barriers to implementation in two districts in Uganda.” Results – It would improve the results section if you clearly delineated the two types of data that have been recorded (facility assessment data and staff perception data). Point well taken. The results have been categorized as quantitative and qualitative results in the abstract. Results barriers to implementation were stated to include under-staffing and lack of funds. However, there is no data included in the abstract to support this The results on barriers come from the qualitative component of the results. This has been clearly separated from the quantitative findings in the abstract.
BACKGROUND About 75% of people living with HIV/AIDS (PHAs) who need antiretroviral therapy have n... more BACKGROUND About 75% of people living with HIV/AIDS (PHAs) who need antiretroviral therapy have no access to these drugs in low-income countries. OBJECTIVE To investigate the barriers to use of ART in Rakai district of Uganda. METHODS We interviewed 38 key informants and 384 PHAs. Data was collected on: education/mobilization for ART, sources of information for ART, beliefs regarding ART, social support, use of alternative medicine, stigma/discrimination towards PHAs, distance to ART centres, transport costs to ART centres, waiting time, and on suggestions as how to improve the use of ART. RESULTS The major barriers mentioned regarding use of ART included: inadequate mobilization, long waiting time at ART treatment centres, high cost of transport to reach ART centres, stigma/discrimination towards PHAs and inadequate number of health workers to attend to PHAs. CONCLUSIONS Access to antiretroviral therapy could be ameliorated by: improving community education using innovative approac...
The literature review on the state of alternative medicine use is inadequate in the background. T... more The literature review on the state of alternative medicine use is inadequate in the background. The concept of alternative and forms of alternative medicine use should be clearly stated in the background/introduction. Authors should cite previous studies from Africa that studies the prevalence of use of alternative medicine in hypertension. Only two of their citations are from Africa and one notable one on the authors missed which is very similar to their study that used a community based approach is the study by Osamor and Owumi (2010) on “complementary and alternative medicine in the management of hypertension in an urban Nigerian Community”. It will also be nice and interesting to compare and contrast the findings from this manuscript prevalence (as well as other findings) with these studies.
Preschool children suffer from morbidity attributable to Schistosoma mansoni. We compared a singl... more Preschool children suffer from morbidity attributable to Schistosoma mansoni. We compared a single and double dose of praziquantel treatment on the regression of S. mansoni associated morbidity in children less than six years in Uganda. We measured the sizes of spleen and liver as well as liver fibrosis before treatment and 8 months after treatment among children who either received one dose (n = 201) or two doses (n = 184) of praziquantel (standard oral dose of 40 mg/kg body weight). Heamoglobin measurements were also taken. Overall, liver enlargement reduced from 52.2% (95% CI (Confidence interval) 45.1, 59.3) to 17.9% (95% CI 12.9, 23.9) with a single dose and from 48.4 (95% CI 40.9, 55.8) to 17.9% (95% CI 12.7, 24.3) with a double dose and there was no significant difference between the changes in proportion of children with enlarged liver between the two treatment groups. The proportion of children with enlarged spleen was not significantly reduced in the group treated with eit...
Objectives: To synthesize evidence on the effectiveness of community-based interventions for card... more Objectives: To synthesize evidence on the effectiveness of community-based interventions for cardiovascular disease (CVD) prevention in low- and middle-income countries (LMICs) to inform design of effective strategies for CVD prevention.Methods: We searched MEDLINE, EMBASE, CINAHL, Cochrane register of controlled studies and PSYCINFO databases for studies published between January 2000 and June 2019. Other studies were identified from gray literature sources and review of reference lists of included studies. The primary outcomes for the review were those aimed at primary prevention of CVD targeting physical activity, diet, smoking and alcohol consumption.Results: Database searches yielded 15,885 articles and 94 articles were identified through snowball searching. After screening, the articles from LMICs were 32 emanating from 27 studies: 9 cluster randomized trials, eight randomized controlled trials and 10 controlled before and after studies. Community-based interventions successfu...
Background: In 2011, the United Nations set out an ambitious plan to dramatically reduce the effe... more Background: In 2011, the United Nations set out an ambitious plan to dramatically reduce the effect of non-communicable diseases (NCDs) including cardiovascular diseases (CVD) in all regions of the world. However, the outbreak of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-Cov-2) is slowing current efforts and the set targets may not be achieved, yet NCDs have been associated with the risk of more severe COVID-19 disease. In the current study, we explore the early impact of the COVID-19 pandemic on a CVD prevention program in Mukono and Buikwe districts in Uganda. Methods: We collected qualitative data through interviews and mini focus group discussions (FGDs) in the months of May and June 2020. A total of 39 community health workers (CHWs) and 10 healthcare workers (HCW) participated in the study. The data were transcribed verbatim and analysed with the help of the ATLAS.ti software following a content analysis approach. Emerging themes and sub themes were generated and these exemplified with quotations from the transcripts. Results: Negative and positive impact themes were observed. The negative observations were: (1) Disruption of CVD prevention services including halting screening for CVD risk factors at the community and health facility, halting sensitisation and health promotion activities at the community; (2) Reduction in patient health seeking behaviours; (3) Acute health facility staff absenteeism (4) Disruption in reporting and referral mechanisms; and (5) Disruption in supply chain. On the other hand, two positive attributes were observed: (1) Perceived reduction in alcohol consumption; and (2) perceived reduction in crime related psychosocial stress. Conclusion: COVID-19 disrupted the implementation of CVD prevention activities in this low-income context. Screening programs and CVD prevention activities at the community and health facility levels were literally halted mainly due to fear, the non-discriminatory lockdown measures and a lack of medicines and supplies – including personal protective equipment. There is need for a balance in measures to sustain CVDs interventions while controlling the COVID-19 pandemic.
Background: Adherence to Antiretroviral Therapy (ART) is required to achieve HIV viral load suppr... more Background: Adherence to Antiretroviral Therapy (ART) is required to achieve HIV viral load suppression. However, children under five years in Jinja, Uganda, had been shown to have low HIV suppression rates. This study aimed to determine the level of ART non-adherence among these children and the associated factors. Methods: Data for the cross-sectional study was collected from April to July 2019, from caregivers of 206 children under five years living with HIV who were attending health facilities in Jinja and had been on ART for at least three months. Non-adherence was measured using a Visual Analog Scale that assessed both dosing and timing non-adherence, and by determining the Proportion of Days Covered by the medication. A questionnaire administered to the caregivers was used to collect the data, together with medical record review. A child was only considered adherent if they had adherence greater than 95% on all the measures. The data was analysed using Modified Poisson Regres...
Background The globally recognized socio-economic benefits of education have stirred many countri... more Background The globally recognized socio-economic benefits of education have stirred many countries in Sub-Saharan Africa like Uganda to promote universal access to schooling by removing fiscal barricades for those in primary and secondary schools. However, the proportion of Youth Living With HIV/AIDS (YLWHA) missing school, studying with difficulties and dropping out of school in Uganda has been observed to be higher than that of other youth. This study aimed at understanding the barriers and facilitators for YLWHA in Uganda to attend school. Methods We conducted a qualitative inquiry with 35 purposively selected YLWHA aged 12 to 19 years, including 16 females at three accredited Antiretroviral Therapy (ART) treatment centres in Kabarole district in Western Uganda. Individual semi-structured interviews were tape-recorded, transcribed verbatim and subjected to thematic inductive analysis. Results We identified five main themes in which barriers to attend school were reported and fou...
Background Cardiovascular diseases (CVDs) are on the rise in many low-and middle-income countries... more Background Cardiovascular diseases (CVDs) are on the rise in many low-and middle-income countries where 80% of related deaths are registered. Community CVD prevention programmes utilizing self-care approaches have shown promise in contributing to population level reduction of risk factors. However, the acceptability of these programmes, which affects their uptake and effectiveness, is unknown including in the sub-Saharan Africa context. This study used the Theoretical Framework of Acceptability to explore the prospective acceptability of a community CVD prevention programme in Mukono and Buikwe districts in Uganda. Methods This qualitative descriptive study was conducted in March 2019 among community health workers (CHWs), who would implement the intervention and community members, the intervention recipients, using eight focus group discussions. All discussions were audio-recorded, transcribed verbatim and analysed thematically guided by the theoretical framework. Results CHWs and ...
BackgroundDrowning is a major cause of unintentional injury death worldwide. The toll is greatest... more BackgroundDrowning is a major cause of unintentional injury death worldwide. The toll is greatest in low and middle-income countries. Over 95% of people who drowned while boating in Uganda were not wearing a lifejacket. We explored the determinants of lifejacket use among boaters on Lake Albert, Uganda.MethodsWe conducted a qualitative enquiry with a hermeneutic phenomenological undertone leaning on relativism ontology and emic subjectivism epistemology. Focus group discussions (FGDs) and in-depth interviews (IDIs) were held with boaters in 10 landing sites. We explored experiences and perspectives on lifejacket use. We used thematic analysis technique to analyse data and report results according to the Consolidated Criteria for Reporting Qualitative Research.ResultsWe recruited 88 boaters in 10 FGDs and 11 to take part in the IDIs. We identified three themes: motivators and opportunities for lifejacket use, barriers and threats to lifejacket use, and strategies to improve lifejacke...
Background: Teso sub-region of Eastern Uganda had superior indices of childhood survival during t... more Background: Teso sub-region of Eastern Uganda had superior indices of childhood survival during the period 1959 to 1969 compared to the national average. We analysed the reasons that could explain this situation with a view of suggesting strategies for reducing childhood mortality. Methods: We compared the childhood mortalities and their average annual reduction rate (AARR) of Teso subregion with those of Uganda for the period 1959 to 1969. We also compared indicators of social economic well being (such as livestock per capita and per capita intake of protein/energy). In addition data was compared on other important determinants of child survival such as level of education and rate of urbanisation. Findings: In 1969 the infant mortality rate (IMR) for Teso was 94 per 1000 live births compared to the 120 for
PURPOSE Tobacco use is the leading cause of premature death worldwide. One aspect of tobacco cont... more PURPOSE Tobacco use is the leading cause of premature death worldwide. One aspect of tobacco control is convincing farmers to stop tobacco production. We assessed the willingness of tobacco farmers in Uganda to stop growing tobacco. METHODS We conducted a cross-sectional interview survey with an interviewer-administered questionnaire. Participants were active tobacco farmers in 12 villages of Kanungu district (N = 528) and were interviewed in 2013 to assess their willingness to stop growing tobacco. RESULTS Most farmers (61.7%) grew tobacco only as a cash crop with no supplemental income. A total of 198 farmers (37.5%) were willing to stop growing tobacco. Ninety-two respondents cited coffee as a potential replacement crop for tobacco and 106 mentioned rice. Barriers to growing replacement crops were that tobacco is highly profitable (n = 172) and that the soil (n = 175) and/or weather (n = 22) cannot sustain any crops other than tobacco. Willingness to stop growing tobacco was 1.32...
Background: Access to HIV testing and subsequent care among health care workers (HCWs) form a cri... more Background: Access to HIV testing and subsequent care among health care workers (HCWs) form a critical component of TB infection control measures for HCWs. Challenges to and gaps in access to HIV services among HCWs may thus compromise TB infection control. This study assessed HCWs HIV and TB screening uptake and explored their preferences for provision of HIV and TB care. Methods: A cross-sectional mixed-methods study involving 499 HCWs and 8 focus group discussions was conducted in Mukono and Wakiso districts in Uganda between October 2010 and February 2011. Results: Overall, 5% of the HCWs reported a history of TB in the past five years. None reported routine screening for TB disease or infection, although 89% were willing to participate in a TB screening program, 77% at the workplace. By contrast, 95% had previously tested for HIV; 34% outside their workplace, and 27% self-tested. Nearly half (45%) would prefer to receive HIV care outside their workplace. Hypothetical willingness to disclose HIV positive status to supervisors was moderate (63%) compared to willingness to disclose to sexual partners (94%). Older workers were more willing to disclose to a supervisor (adjusted prevalence ratio [APR] = 1.51, CI = 1.16-1.95). Being female (APR = 0.78, CI = 0.68-0.91), and working in the private sector (APR = 0.81, CI = 0.65-1.00) were independent predictors of unwillingness to disclose a positive HIV status to a supervisor. HCWs preferred having integrated occupational services, versus stand-alone HIV care. Conclusions: Discomfort with disclosure of HIV status to supervisors suggests that universal TB infection control measures that benefit all HCWs are more feasible than distinctions by HIVstatus, particularly for women, private sector, and younger HCWs. However, interventions to reduce stigma and ensuring confidentiality are also essential to ensure uptake of comprehensive HIV care including Isoniazid Preventive Therapy among HCWs.
Disclosure of HIV positive sero-status to sexual partners, friends or relatives is useful for pre... more Disclosure of HIV positive sero-status to sexual partners, friends or relatives is useful for prevention and care. Identifying factors associated with disclosure is a research priority as a high proportion of persons living with HIV/AIDS (PHA) never disclose. To identify factors associated with disclosure among PHAs in Mityana district of Uganda. Using a case control design, we compared 139 PHAs who had disclosed to 139 PHA who had not disclosed regarding socio demographic characteristics, sexual behaviour, individual experiences and perceptions about disclosure, as well as on health facility/community correlates of disclosure. The independent factors that favour disclosure are not fearing negative outcomes of disclosure adjusted odds ratio (AOR) 7.00, 95 % confidence interval (95% CI) 3.03-16.95, having communication skills to disclose (AOR 12.08, 95% CI 4.94-29.51), having initiated anti-retroviral therapy (AOR 7.51, 95% CI 3.42-16.49), not having tested for HIV during ante-natal ...
Background: Prevention and control of hypertension are critical in reducing morbidity and mortali... more Background: Prevention and control of hypertension are critical in reducing morbidity and mortality attributable to cardiovascular diseases. Awareness of hypertension is a pre-condition for control and prevention. This study estimated the proportion of adults who were hypertensive, were aware of their hypertension and those that achieved adequate control. Methods: We conducted a community based cross sectional survey among people$15 years in Buikwe and Mukono districts of Uganda. People had their blood pressure measured and were interviewed about their social-demographic characteristics. Hypertension was defined as systolic blood pressure $140 mmHg, or diastolic blood pressure $90 mmHg, or previous diagnosis of hypertension. Participants were classified as hypertensive aware if they reported that they had previously been informed by a health professional that they had hypertension. Control of hypertension among those aware was if systolic blood pressure was,140 mmHg and diastolic bl...
Background: A large, district-wide, home-based HIV counselling and testing (HBHCT) programme was ... more Background: A large, district-wide, home-based HIV counselling and testing (HBHCT) programme was implemented in Bushenyi district of Uganda from 2004 to 2007. This programme provided free HBHCT services to all consenting adults of Bushenyi district and had a very high uptake and acceptability. We measured population-level changes in knowledge of HIV status, stigma and HIV-risk behaviours before and after HBHCT to assess whether widespread HBHCT had an effect on trends of risky sexual behaviours and on stigma and discrimination towards HIV. Methods: Serial cross-sectional surveys were carried out before and after the implementation of HBHCT programme in Bushenyi district of Uganda. A total of 1402 randomly selected adults (18 to 49 years) were interviewed in the baseline survey. After the implementation, a different set of randomly selected 1562 adults was interviewed using the same questionnaire. Data was collected on socio-demographic characteristics, sexual behaviour, whether resp...
Study aim – the explicit study aim is not consistent with the outcomes, which suggest that the st... more Study aim – the explicit study aim is not consistent with the outcomes, which suggest that the study aim was to assess implementation of TB IC practices. This needs to be clarified. This comment is well taken. We now state “The study aim was to assess implementation of TBIC practices and barriers to implementation in two districts in Uganda.” Results – It would improve the results section if you clearly delineated the two types of data that have been recorded (facility assessment data and staff perception data). Point well taken. The results have been categorized as quantitative and qualitative results in the abstract. Results barriers to implementation were stated to include under-staffing and lack of funds. However, there is no data included in the abstract to support this The results on barriers come from the qualitative component of the results. This has been clearly separated from the quantitative findings in the abstract.
BACKGROUND About 75% of people living with HIV/AIDS (PHAs) who need antiretroviral therapy have n... more BACKGROUND About 75% of people living with HIV/AIDS (PHAs) who need antiretroviral therapy have no access to these drugs in low-income countries. OBJECTIVE To investigate the barriers to use of ART in Rakai district of Uganda. METHODS We interviewed 38 key informants and 384 PHAs. Data was collected on: education/mobilization for ART, sources of information for ART, beliefs regarding ART, social support, use of alternative medicine, stigma/discrimination towards PHAs, distance to ART centres, transport costs to ART centres, waiting time, and on suggestions as how to improve the use of ART. RESULTS The major barriers mentioned regarding use of ART included: inadequate mobilization, long waiting time at ART treatment centres, high cost of transport to reach ART centres, stigma/discrimination towards PHAs and inadequate number of health workers to attend to PHAs. CONCLUSIONS Access to antiretroviral therapy could be ameliorated by: improving community education using innovative approac...
The literature review on the state of alternative medicine use is inadequate in the background. T... more The literature review on the state of alternative medicine use is inadequate in the background. The concept of alternative and forms of alternative medicine use should be clearly stated in the background/introduction. Authors should cite previous studies from Africa that studies the prevalence of use of alternative medicine in hypertension. Only two of their citations are from Africa and one notable one on the authors missed which is very similar to their study that used a community based approach is the study by Osamor and Owumi (2010) on “complementary and alternative medicine in the management of hypertension in an urban Nigerian Community”. It will also be nice and interesting to compare and contrast the findings from this manuscript prevalence (as well as other findings) with these studies.
Preschool children suffer from morbidity attributable to Schistosoma mansoni. We compared a singl... more Preschool children suffer from morbidity attributable to Schistosoma mansoni. We compared a single and double dose of praziquantel treatment on the regression of S. mansoni associated morbidity in children less than six years in Uganda. We measured the sizes of spleen and liver as well as liver fibrosis before treatment and 8 months after treatment among children who either received one dose (n = 201) or two doses (n = 184) of praziquantel (standard oral dose of 40 mg/kg body weight). Heamoglobin measurements were also taken. Overall, liver enlargement reduced from 52.2% (95% CI (Confidence interval) 45.1, 59.3) to 17.9% (95% CI 12.9, 23.9) with a single dose and from 48.4 (95% CI 40.9, 55.8) to 17.9% (95% CI 12.7, 24.3) with a double dose and there was no significant difference between the changes in proportion of children with enlarged liver between the two treatment groups. The proportion of children with enlarged spleen was not significantly reduced in the group treated with eit...
Objectives: To synthesize evidence on the effectiveness of community-based interventions for card... more Objectives: To synthesize evidence on the effectiveness of community-based interventions for cardiovascular disease (CVD) prevention in low- and middle-income countries (LMICs) to inform design of effective strategies for CVD prevention.Methods: We searched MEDLINE, EMBASE, CINAHL, Cochrane register of controlled studies and PSYCINFO databases for studies published between January 2000 and June 2019. Other studies were identified from gray literature sources and review of reference lists of included studies. The primary outcomes for the review were those aimed at primary prevention of CVD targeting physical activity, diet, smoking and alcohol consumption.Results: Database searches yielded 15,885 articles and 94 articles were identified through snowball searching. After screening, the articles from LMICs were 32 emanating from 27 studies: 9 cluster randomized trials, eight randomized controlled trials and 10 controlled before and after studies. Community-based interventions successfu...
Background: In 2011, the United Nations set out an ambitious plan to dramatically reduce the effe... more Background: In 2011, the United Nations set out an ambitious plan to dramatically reduce the effect of non-communicable diseases (NCDs) including cardiovascular diseases (CVD) in all regions of the world. However, the outbreak of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-Cov-2) is slowing current efforts and the set targets may not be achieved, yet NCDs have been associated with the risk of more severe COVID-19 disease. In the current study, we explore the early impact of the COVID-19 pandemic on a CVD prevention program in Mukono and Buikwe districts in Uganda. Methods: We collected qualitative data through interviews and mini focus group discussions (FGDs) in the months of May and June 2020. A total of 39 community health workers (CHWs) and 10 healthcare workers (HCW) participated in the study. The data were transcribed verbatim and analysed with the help of the ATLAS.ti software following a content analysis approach. Emerging themes and sub themes were generated and these exemplified with quotations from the transcripts. Results: Negative and positive impact themes were observed. The negative observations were: (1) Disruption of CVD prevention services including halting screening for CVD risk factors at the community and health facility, halting sensitisation and health promotion activities at the community; (2) Reduction in patient health seeking behaviours; (3) Acute health facility staff absenteeism (4) Disruption in reporting and referral mechanisms; and (5) Disruption in supply chain. On the other hand, two positive attributes were observed: (1) Perceived reduction in alcohol consumption; and (2) perceived reduction in crime related psychosocial stress. Conclusion: COVID-19 disrupted the implementation of CVD prevention activities in this low-income context. Screening programs and CVD prevention activities at the community and health facility levels were literally halted mainly due to fear, the non-discriminatory lockdown measures and a lack of medicines and supplies – including personal protective equipment. There is need for a balance in measures to sustain CVDs interventions while controlling the COVID-19 pandemic.
Background: Adherence to Antiretroviral Therapy (ART) is required to achieve HIV viral load suppr... more Background: Adherence to Antiretroviral Therapy (ART) is required to achieve HIV viral load suppression. However, children under five years in Jinja, Uganda, had been shown to have low HIV suppression rates. This study aimed to determine the level of ART non-adherence among these children and the associated factors. Methods: Data for the cross-sectional study was collected from April to July 2019, from caregivers of 206 children under five years living with HIV who were attending health facilities in Jinja and had been on ART for at least three months. Non-adherence was measured using a Visual Analog Scale that assessed both dosing and timing non-adherence, and by determining the Proportion of Days Covered by the medication. A questionnaire administered to the caregivers was used to collect the data, together with medical record review. A child was only considered adherent if they had adherence greater than 95% on all the measures. The data was analysed using Modified Poisson Regres...
Background The globally recognized socio-economic benefits of education have stirred many countri... more Background The globally recognized socio-economic benefits of education have stirred many countries in Sub-Saharan Africa like Uganda to promote universal access to schooling by removing fiscal barricades for those in primary and secondary schools. However, the proportion of Youth Living With HIV/AIDS (YLWHA) missing school, studying with difficulties and dropping out of school in Uganda has been observed to be higher than that of other youth. This study aimed at understanding the barriers and facilitators for YLWHA in Uganda to attend school. Methods We conducted a qualitative inquiry with 35 purposively selected YLWHA aged 12 to 19 years, including 16 females at three accredited Antiretroviral Therapy (ART) treatment centres in Kabarole district in Western Uganda. Individual semi-structured interviews were tape-recorded, transcribed verbatim and subjected to thematic inductive analysis. Results We identified five main themes in which barriers to attend school were reported and fou...
Background Cardiovascular diseases (CVDs) are on the rise in many low-and middle-income countries... more Background Cardiovascular diseases (CVDs) are on the rise in many low-and middle-income countries where 80% of related deaths are registered. Community CVD prevention programmes utilizing self-care approaches have shown promise in contributing to population level reduction of risk factors. However, the acceptability of these programmes, which affects their uptake and effectiveness, is unknown including in the sub-Saharan Africa context. This study used the Theoretical Framework of Acceptability to explore the prospective acceptability of a community CVD prevention programme in Mukono and Buikwe districts in Uganda. Methods This qualitative descriptive study was conducted in March 2019 among community health workers (CHWs), who would implement the intervention and community members, the intervention recipients, using eight focus group discussions. All discussions were audio-recorded, transcribed verbatim and analysed thematically guided by the theoretical framework. Results CHWs and ...
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Papers by Fred Nuwaha