RESUMEN
OBJECTIVE: To determine the competence of community health workers (CHWs) to correctly assess, classify and treat malaria and pneumonia among under-five children after training. METHODS: Consultations of 182 under-fives by 14 CHWs in Iganga district, Uganda, were observed using standardised checklists. Each CHW saw 13 febrile children. Two paediatricians observed CHWs' assessment, classification and prescription of treatment, while a laboratory scientist assessed CHW use of malaria rapid diagnostic tests (RDTs). The validity of CHWs' use of RDTs to detect malaria and respiratory timers to diagnose pneumonia was estimated using a laboratory scientist's RDT repeat reading and a paediatrician's repeat count of the respiratory rate, respectively. RESULTS: From the 182 consultations, overall CHWs' performance was adequate in taking history (97%), use (following procedures prior to reading result) of timers (96%) and use of RDTs (96%), but inadequate in classification (87%). Breath readings (classified as fast or normal) were 85% in agreement with the paediatrician (κ = 0.665, P < 0.001). All RDT readings were in agreement with those obtained by the laboratory scientist. Ninety-six per cent (85/89) of children with a positive RDT were prescribed an antimalarial drug, 40% (4/10) with fast breathing (gold standard) were prescribed an antibiotic and 91% (48/53) with both were prescribed both medicines. CONCLUSION: Community health workers can be trained to use RDTs and timers to assess and manage malaria and pneumonia in children. We recommend integration of these diagnostics into community case management of fever. CHWs require enhanced practice in counting respiratory rates and simple job aides to enable them make a classification without thinking deeply about several assessment results.
Asunto(s)
Antiinfecciosos/administración & dosificación , Manejo de Caso , Agentes Comunitarios de Salud/educación , Fiebre/etiología , Malaria/diagnóstico , Malaria/tratamiento farmacológico , Neumonía/diagnóstico , Neumonía/tratamiento farmacológico , Frecuencia Respiratoria , Población Rural , Adulto , Antimaláricos/administración & dosificación , Manejo de Caso/organización & administración , Manejo de Caso/normas , Manejo de Caso/tendencias , Preescolar , Coinfección , Diagnóstico Diferencial , Femenino , Fiebre/microbiología , Fiebre/parasitología , Humanos , Lactante , Personal de Laboratorio/estadística & datos numéricos , Malaria/epidemiología , Malaria/fisiopatología , Masculino , Persona de Mediana Edad , Neumonía/epidemiología , Neumonía/fisiopatología , Prevalencia , Proyectos de Investigación , Población Rural/estadística & datos numéricos , Población Rural/tendencias , Uganda/epidemiologíaRESUMEN
OBJECTIVES: To assess tuberculosis (TB) knowledge, attitudes and health-seeking behaviour to inform the design of communication and social mobilisation interventions. SETTING: Iganga/Mayuge Demographic Surveillance Site, Uganda. DESIGN: Between June and July 2008, 18 focus group discussions and 12 key informant interviews were conducted, including parents of infants and adolescents and key informant interviews with community leaders, traditional healers and patients with TB. RESULTS: People viewed TB as contagious, but not necessarily an airborne pathogen. Popular TB aetiologies included sharing utensils, heavy labour, smoking, bewitchment and hereditary transmission. TB patients were perceived to seek care late or to avoid care. Combining care from traditional healers and the biomedical system was common. Poverty, drug stock-outs, fear of human immunodeficiency virus (HIV) testing and length of TB treatment negatively affect health-seeking behaviour. Stigma and avoidance of persons with TB often reflects an assumption of HIV co-infection. CONCLUSION: The community's concerns about pill burden, quality of care, financial barriers, TB aetiology, stigma and preference for pluralistic care need to be addressed to improve early detection. Health education messages should emphasise the curability of TB, the feasibility of treatment and the engagement of traditional healers as partners in identifying cases and facilitating adherence to treatment.
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Actitud Frente a la Salud , Conocimientos, Actitudes y Práctica en Salud , Aceptación de la Atención de Salud/estadística & datos numéricos , Tuberculosis/psicología , Adolescente , Adulto , Recolección de Datos , Femenino , Grupos Focales , Educación en Salud/métodos , Humanos , Lactante , Masculino , Medicinas Tradicionales Africanas , Padres/psicología , Población Rural , Estereotipo , UgandaRESUMEN
OBJECTIVES: Future Health Systems: Innovations for Equity (FHS) is working in six partner countries in Asia and Africa, focusing on strengthening the research-policy interface in relation to specific health system research projects. These projects present an opportunity to study the influence of stakeholders on research and policy processes. STUDY DESIGN: Qualitative stakeholder analysis. METHODS: Stakeholder analysis was conducted in each FHS country using a structured approach. A cross-country evaluation was performed concentrating on six key areas: chosen research topic; type of intervention considered; inclusion/exclusion of stakeholder groups; general stakeholder considerations; power level, power type and agreement level of stakeholders; and classification of and approaches to identified stakeholders. RESULTS: All six countries identified a range of stakeholders but each country had a different focus. Four of the six countries identified stakeholders in addition to the guidelines, while some of the stakeholder categories were not identified by countries. The mean power level of identified stakeholders was between 3.4 and 4.5 (1=very low; 5=very high). The percentage of classified stakeholders that were either drivers or supporters ranged from 60% to 91%. CONCLUSION: Three important common areas emerge when examining the execution of the FHS country stakeholder analyses: clarity on the purpose of the analyses; value of internal vs external analysts; and the role of primary vs secondary analyses. This paper adds to the global body of knowledge on the utilization of stakeholder analysis to strengthen the research-policy interface in the developing world.
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Política de Salud , Investigación sobre Servicios de Salud , Estudios de Casos Organizacionales/métodos , Pobreza , África , Asia , Comparación Transcultural , Toma de Decisiones en la Organización , Medicina Basada en la Evidencia , Humanos , Investigación , Factores SocioeconómicosRESUMEN
BACKGROUND: Improved case management of paediatric pneumonia is recognised as a key strategy for pneumonia control. Since symptoms of pneumonia and malaria often overlap, there are concerns that children with pneumonia are treated with antimalarial drugs. There is a need to describe how children with severe pneumonia have been managed prior to their arrival at hospital, including possible risks of developing more severe disease. METHODS: A case-series study of 140 children, aged 2-59 months, with severe radiologically verified pneumonia at Mulago Hospital, Kampala was undertaken. Caretakers were interviewed about initial symptoms, treatment given and care sought. Using WHO definitions, children were clinically classified as having severe or very severe pneumonia. RESULTS: The children had been ill for a median of 7 days before arrival at hospital, 90/140 (64%) had received treatment at home, and 72/140 (51%) had seen another health-care provider prior to presentation at hospital. Altogether, 32/140 (23%) children had reportedly received antibiotics only prior to admission, 18/140 (13%) had received anti-malarials only and 35/140 (25%) had received both. Being classified as very severe pneumonia was more common among children who had received anti-malarials only (OR 5.5, 1.8-16.4). CONCLUSIONS: Although the majority of caretakers were able to recognise the key symptoms of pneumonia, they did not respond with any immediate care-giving action. Since progression from first recognition of pneumonia symptoms to severe disease is rapid, management guidelines regarding timing of care-seeking need to be clearly defined. The reason why children who sought health facility care failed to improve should be investigated. Meanwhile, there is a need to increase caretakers' and health workers' awareness of the urgency to act promptly when key pneumonia symptoms are observed.
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Neumonía/diagnóstico , Antibacterianos/uso terapéutico , Antimaláricos/uso terapéutico , Preescolar , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Países en Desarrollo , Diagnóstico Diferencial , Femenino , Humanos , Lactante , Malaria/diagnóstico , Masculino , Aceptación de la Atención de Salud , Neumonía/tratamiento farmacológico , Factores de Riesgo , UgandaRESUMEN
INTRODUCTION: Financial access to promotive, preventive, curative and rehabilitative healthcare by every one remains a challenge globally. The requirement to make direct payments at the time of consuming health services is one of the reasons why it persists. In this paper, we present findings on the financial risks households bear as a result of healthcare consumption in one district in Uganda. METHODOLOGY: Using simple random sampling, we selected 384 household heads in 3 health sub districts. A structured questionnaire was to conduct the survey. Focus group discussions and Key Informant interviews were also conducted. RESULTS: Up to 77% (297/384) of households reported making direct payments for healthcare when a household member fell ill, 45% (174/384) did so each time a household member fell ill. Payment for healthcare was associated with employment of the household head in the informal sector (OR 1.6, 95% 1.2-2.1), presence of children OR 1.5, 95% 1.3-1.9 or someone with chronic illness OR 3, 95% 1.5-6 respectively and history of hospitalization (OR 3, 95% 1.7-6.5). CONCLUSION: A high burden of healthcare needs, disproportionately affect children and women among households in Jinja. Direct payments for healthcare still occur in spite of the abolishment of user fees at public health facilities and tax based financing of health services in Uganda.
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Servicios de Salud Comunitaria/economía , Financiación Personal , Gastos en Salud , Accesibilidad a los Servicios de Salud/economía , Necesidades y Demandas de Servicios de Salud/economía , Adulto , Niño , Servicios de Salud del Niño/economía , Servicios de Salud del Niño/estadística & datos numéricos , Servicios de Salud Comunitaria/estadística & datos numéricos , Estudios Transversales , Composición Familiar , Femenino , Encuestas de Atención de la Salud , Disparidades en Atención de Salud/economía , Humanos , Entrevistas como Asunto , Modelos Logísticos , Masculino , Aceptación de la Atención de Salud , Riesgo , Factores Socioeconómicos , Uganda , Servicios de Salud para Mujeres/economía , Servicios de Salud para Mujeres/estadística & datos numéricosRESUMEN
Introduction: Financial access to promotive; preventive; curative and rehabilitative healthcare by every one remains a challenge globally. The requirement to make direct payments at the time of consuming health services is one of the reasons why it persists. In this paper; we present findings on the financial risks households bear as a result of healthcare consumption in one district in Uganda. Methodology: Using simple random sampling; we selected 384 household heads in 3 health sub districts. A structured questionnaire was to conduct the survey. Focus group discussions and Key Informant interviews were also conducted. Results: Up to 77(297/384) of households reported making direct payments for healthcare when a household member fell ill; 45(174/384) did so each time a household member fell ill. Payment for healthcare was associated with employment of the household head in the informal sector (OR 1.6; 951.2-2.1); presence of children OR 1.5; 951.3-1.9 or someone with chronic illness OR 3; 951.5-6 respectively and history of hospitalization (OR 3; 951.7-6.5). Conclusion: A high burden of healthcare needs; disproportionately affect children and women among households in Jinja. Direct payments for healthcare still occur in spite of the abolishment of user fees at public health facilities and tax based financing of health services in Uganda
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Atención a la Salud , Familia , Gastos en SaludRESUMEN
Inequalities in the burden of disease and access to health care is a prominent concern in Uganda and other sub-Saharan African countries. This is a systematic review of socio-economic differences in morbidity and access to health care in Uganda. It includes published studies from electronic databases and official reports from surveys done by government, bilateral and multilateral agencies and universities. The outcome measures studied were: the distribution of HIV/AIDS; maternal and child morbidity; and access to and utilisation of health services for people belonging to different socio-economic and vulnerability groups. Forty-eight of 678 identified studies met our inclusion criteria. Results indicate that the poor and vulnerable experience a greater burden of disease but have lower access to health services than the less poor. Barriers to access arise from both the service providers and the consumers. Distance to service points, perceived quality of care and availability of drugs are key determinants of utilisation. Other barriers are perceived lack of skilled staff in public facilities, late referrals, health worker attitude, costs of care and lack of knowledge. Longitudinal and controlled studies are needed to see if strategies to improve access to services reach the poor.
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Servicios de Salud del Niño/estadística & datos numéricos , Infecciones por VIH/mortalidad , Accesibilidad a los Servicios de Salud/economía , Disparidades en Atención de Salud/economía , Servicios de Salud Materna/estadística & datos numéricos , Pobreza , Adulto , Niño , Países en Desarrollo , Femenino , Humanos , Masculino , Calidad de la Atención de Salud , Factores Socioeconómicos , UgandaRESUMEN
BACKGROUND: Uganda has not achieved the 2005 neonatal tetanus (NNT) global elimination target set by the World Health Organization (WHO). The Busoga region has the highest recorded level of NNT incidence in Uganda. To understand the reasons for this high incidence, a study was conducted to identify NNT risk factors. METHODS: During March-May 2004, a matched case-control study was conducted in the Busoga region for a 2-year study period (2002-2003). Matching variables were sex, residence, and date of birth. A total of 24 cases of NNT (according to the WHO case definition) were identified from hospital records, and 96 community controls (children who survived the neonatal period) were selected. RESULTS: Bivariate analysis indicated that neonates with NNT were more likely to have been delivered outside a health facility, on an unclean surface, without use of gloves, or by unskilled attendants. Mothers of these neonates were less likely to report vaccination during previous pregnancies, administration of 2 doses of tetanus toxoid (TT) during the study pregnancy, or use of certain intravaginal substances (most commonly, herbs) at onset of labor. Multivariate analysis indicated that unclean delivery surfaces (odds ratio [OR] = 38.8; 95% confidence interval [CI] = 2.9-518.1) and primigravidae mothers (OR = 79.5; CI = 1.8-3,472.2) were associated with NNT. Administration of 2 doses of TT during pregnancy, vaccination during previous pregnancies, and intravaginal application of certain substances were protective against NNT. CONCLUSION: These findings underscore the importance of having clean delivery surfaces and of mothers receiving 2 doses of TT during pregnancy. Implementation of these measures might help eliminate NNT from the Busoga region of Uganda.
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Tétanos/epidemiología , Estudios de Casos y Controles , Parto Obstétrico , Femenino , Humanos , Recién Nacido , Control de Infecciones , Masculino , Factores de Riesgo , Tétanos/prevención & control , Tétanos/transmisión , Toxoide Tetánico , Uganda/epidemiologíaRESUMEN
BACKGROUND: The number of orphans in Rakai district, Uganda is estimated to be 34,902 (OCBO, 2000) which translates into 28% of children under the age of 18 years. Young people who have been orphaned and as a result became heads of households must look after themselves and their siblings. These children are likely to be faced with several health problems and have to take crucial life decisions without parental/adult guidance. OBJECTIVES: This study was conducted in order to understand how child-headed households, Rakai district in Uganda recognize malaria, their health-seeking behavior when malaria is suspected and reasons for the type of behavior compared to the adult-headed households. METHODS: A comparative cross-sectional study was conducted in 300 households in Rakai district, Uganda, in which 8/23 (35%) of sub-counties and 150 child-headed households were included. The closest neighborhood adult-headed household to each child-headed household was selected for comparison. Individual interview was carried out with the respondents using semi-structure questionnaire. Key informant interview and focus group discussions were also conducted. RESULTS: The main findings were that the respondents in child-headed households had less knowledge on signs and symptoms of simple and severe malaria compared to adult heads of households. Respondents in child-headed households were less likely to seek health care from health facilities (OR=0.59, CI=0.36-0.97, p-value=0.028). There was no significant difference in the time lag before taking first action in the two types of households (OR=0.72, CI=0.42-1.22, p-value=0.194). The respondents in child-headed households were six times (OR=5.70,CI=2.75-11.91, p-value<0.001) more likely to use local herb for treatment of malaria than the adult heads households. Major reasons stated by the respondents for choosing where health care is sought included distance to source of health care, cheap or free treatment, availability of drugs, and quick services to patients. CONCLUSION: The respondents in child-headed households had less knowledge on signs and symptoms of simple and severe malaria and receive too little or late health care from health professionals compared to the adult heads of households probably due to lack of knowledge and money. Information Communication and Education programs should be designed and target the child-headed households and supply home packs.