EDCTP Alumni Network

Fostering excellence and collaboration in the next generation of researchers

Call Career Development Fellowship (CDF)
Programme EDCTP2
Start Date 2021-03-01
End Date 2024-02-29
Project Code TMA2020CDF-3189
Status Active

Title

Integrated malaria prevention in rural communities in Uganda: an implementation research

Host Organisation

Institution Country
Makerere University - School of Public Health Uganda

Current Organisation

Makerere University School of Public Health, Kampala, Uganda

Current Job Title

Senior Lecturer

Memberships

Role Committee/board Start Date End Date
Academic Editor PLOS Global Public Health 2021
Academic Editor BMC Health Services Research 2021
Academic Editor BMC Public Health 2021
Academic Editor Journal of Environmental and Public Health 2020

Education

Institution Degree Year
Cardiff Metropolitan University, United Kingdom PhD 2015-12-15
University of London, United Kingdom MSc 2010-04-12
Makerere University, Uganda Bachelors in Environmental Health Sciences 2006-10-05

Areas Of Specialisation

Malaria

Publications

Authors:
David Musoke , author
Charles Ssemugabo , author
Rawlance Ndejjo , author
Edwinah Atusingwize , author
Trasias Mukama , author
Linda Gibson , author
Date:
2019-12-01
Journal:
BMC Research Notes
Content:
Identifiers:
Authors:
Date:
2021-01-07
Journal:
Globalization and Health
Content:
Abstract Background Community health workers (CHWs) are an important cadre of the global health workforce as they are involved in providing health services at the community level. However, evidence on the role of CHWs in delivering interventions for non-communicable diseases (NCDs) in Uganda is limited. This study, therefore, assessed the involvement of CHWs in the prevention and control of NCDs in Wakiso District, Uganda with a focus on their knowledge, attitudes and practices, as well as community perceptions. Methods A cross-sectional study using mixed methods was conducted which involved a structured questionnaire among 485 CHWs, and 6 focus group discussions (FGDs) among community members. The study assessed knowledge, perceptions including the importance of the various risk factors, and the current involvement of CHWs in NCDs, including the challenges they faced. Quantitative data were analysed in STATA version 13.0 while thematic analysis was used for the qualitative data. Results The majority of CHWs (75.3%) correctly defined what NCDs are. Among CHWs who knew examples of NCDs (87.4%), the majority mentioned high blood pressure (77.1%), diabetes (73.4%) and cancer (63.0%). Many CHWs said that healthy diet (86.2%), physical activity (77.7%), avoiding smoking/tobacco use (70.9%), and limiting alcohol consumption (63.7%) were very important to prevent NCDs. Although more than half of the CHWs (63.1%) reported being involved in NCDs activities, only 20.9 and 20.6% had participated in community mobilisation and referral of patients respectively. The majority of CHWs (80.1%) who were involved in NCDs prevention and control reported challenges including inadequate knowledge (58.4%), lack of training (37.6%), and negative community perception towards NCDs (35.1%). From the FGDs, community members were concerned that CHWs did not have enough training on NCDs hence lacked enough information. Therefore, the community did not have much confidence in them regarding NCDs, hence rarely consulted them concerning these diseases. Conclusions Despite CHWs having some knowledge on NCDs and their risk factors, their involvement in the prevention and control of the diseases was low. Through enhanced training and community engagement, CHWs can contribute to the prevention and control of NCDs, including health education and community mobilisation.
Identifiers:
Authors:
David Musoke , author
Carol Namata , author
Grace Biyinzika Lubega , author
Freddy Eric Kitutu , author
Lawrence Mugisha , author
Saba Amir , author
Claire Brandish , author
Joviah Gonza , author
Deborah Ikhile , author
Filimin Niyongabo , author
Bee Yean Ng , author
Jean O’Driscoll , author
Kate Russell-Hobbs , author
Jody Winter , author
Linda Gibson , author
Date:
2021-12-01
Journal:
Journal of Pharmaceutical Policy and Practice
Content:
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Date:
2018-12-01
Journal:
Globalization and Health
Content:
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Date:
2021-10-04
Journal:
BMC Pediatrics
Content:
Abstract Background Social inclusion establishes a basis for the overall wellbeing of children with special needs. Although children’s lives are centred around the household, little is known about the household’s influence on social inclusion. Therefore, the aim is to investigate the household’s role in the social inclusion of children with special needs in Uganda. Methods Twelve carers of children with special needs participated in this photovoice study on the outskirts of Kampala, Uganda – including a training workshop, home visits, in-depth individual interviews and focus group discussion. Results The social inclusion of children with special needs is highly complex because it has the potential to both benefit and cause harm. The results show that when a disability is socially devalued to a certain degree, carers and their household members have to deal with the ongoing process of stigma management. Depending on the characteristics of the child, carer and household, this can lead to an upward spiral towards visibility or a downward spiral towards concealment – reinforcing social inclusion or stigma, respectively. Conclusions Despite the fact that there is disability among Ugandan children it remains a ‘hidden reality’. This research helps to reveal this hidden reality by understanding the role of the household in social inclusion in a stigmatized context.
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Date:
2015-05-28
Journal:
African Health Sciences
Content:
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DOI: 10.4314/ahs.v15i2.13
Part of ISSN: 1680-6905
Authors:
Date:
2021-10-01
Journal:
Health Research Policy and Systems
Content:
Abstract Background This is the concluding paper of our 11-paper supplement, “Community health workers at the dawn of a new era”. Methods We relied on our collective experience, an extensive body of literature about community health workers (CHWs), and the other papers in this supplement to identify the most pressing challenges facing CHW programmes and approaches for strengthening CHW programmes. Results CHWs are increasingly being recognized as a critical resource for achieving national and global health goals. These goals include achieving the health-related Sustainable Development Goals of Universal Health Coverage, ending preventable child and maternal deaths, and making a major contribution to the control of HIV, tuberculosis, malaria, and noncommunicable diseases. CHWs can also play a critical role in responding to current and future pandemics. For these reasons, we argue that CHWs are now at the dawn of a new era. While CHW programmes have long been an underfunded afterthought, they are now front and centre as the emerging foundation of health systems. Despite this increased attention, CHW programmes continue to face the same pressing challenges: inadequate financing, lack of supplies and commodities, low compensation of CHWs, and inadequate supervision. We outline approaches for strengthening CHW programmes, arguing that their enormous potential will only be realized when investment and health system support matches rhetoric. Rigorous monitoring, evaluation, and implementation research are also needed to enable CHW programmes to continuously improve their quality and effectiveness. Conclusion A marked increase in sustainable funding for CHW programmes is needed, and this will require increased domestic political support for prioritizing CHW programmes as economies grow and additional health-related funding becomes available. The paradigm shift called for here will be an important step in accelerating progress in achieving current global health goals and in reaching the goal of Health for All.
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Date:
2021-12-14
Journal:
African Health Sciences
Content:
Background: Stigma continues to be a major barrier to tuberculosis (TB) control particularly in urban populations. Stigma can influence health seeking behaviour and affect adherence to TB treatment, yet few studies have examined TB related stigma and associated factors in Uganda. This study was therefore conducted to determine the level of stigma and associated factors among TB patients in an urban setting in Kampala, Uganda. Methods: A cross-sectional study was conducted in Makindye division, Kampala among 204 patients with TB aged 18 years and above. Data were collected on socio-demographic, individual patient and HIV/AIDS related factors using an intervieweradministered questionnaire. The outcome variable (stigma) was assessed on a four-point Likert scale from the participants’ perspective. Stigma scores ranged from 0 to 36 which were summed up and a median stigma score calculated. Individuals with a stigma score equal or greater than the median were categorized as having high stigma. A multivariable logistic regression analysis was performed to determine factors associated with TB stigma. Results: Over half (52%) of the participants were found to have high TB stigma. Knowing someone who had died of TBAOR = 4.42, 95% CI (1.69 - 11.50) and believing that TB and HIV symptoms were similarAOR = 3.05, 95% CI (1.29 - 7.22) were positively associated with high TB stigma. The odds of having high stigma were 79% lower among individuals who had been previously treated for TBAOR = 0.21, 95% CI (0.09 - 0.52). Conclusions: Stigma towards TB was high in this urban population and mainly associated with knowing a person who had died of TB, perception that symptoms of TB are similar to those of HIV/AIDS, and previous TB treatment. Interventions to mitigate TB stigma are needed in urban populations and should also address HIV/AIDS related stigma. Key terms: Stigma; tuberculosis; health facility; urban population; Uganda.
Identifiers:
DOI: 10.4314/ahs.v21i4.18
Part of ISSN: 1680-6905
Authors:
Date:
2021-08-10
Journal:
Pilot and Feasibility Studies
Content:
Abstract Background A randomised controlled trial (RCT) on integrated malaria prevention, which advocates the use of several malaria prevention methods holistically, has been proposed. However, before conducting an RCT, it is recommended that a feasibility study is carried out to provide information to support the main study, particularly for such a complex intervention. Therefore, a feasibility study for an RCT on integrated malaria prevention in Uganda was conducted. Methods The qualitative study carried out in Wakiso District employed focus group discussions (FGDs) and key informant interviews (KIIs) to explore community willingness to participate in the RCT as well as assess stakeholder perspectives on the future study. The participants of the FGDs were community members, while the key informants were selected from malaria stakeholders including Ministry of Health officials, health practitioners, local leaders, district health team members, and community health workers (CHWs). Thematic analysis was employed with the support of NVivo. Results A total of 12 FGDs and 19 KIIs were conducted. Five main themes emerged from the study: malaria prevention practices related to integrated malaria prevention; preferred malaria prevention methods in the integrated approach; potential challenges of integrated malaria prevention; perspectives on the proposed RCT; and sustainability of integrated malaria prevention. Despite a few methods being employed holistically in the community, insecticide-treated nets were the most widely used and preferred method for malaria prevention mainly because they were provided free by the government. The main challenges in the integrated approach were the high cost of some methods such as house screening, and concerns about the potential side effects of insecticide-based methods such as indoor residual spraying. Participants expressed high willingness to participate in the RCT to promote the use of multiple methods in their households and community. Involvement of CHWs during implementation was proposed as a sustainability strategy for the RCT interventions. Conclusion There was high willingness to participate in the proposed RCT on integrated malaria prevention. However, high cost and perceived negative health effects from some methods were identified as potential challenges. The type of methods to be included as well as sustainability mechanisms needs to be considered during the design of the RCT.
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Date:
2020-12-14
Journal:
Sexual and Reproductive Health Matters
Content:
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Date:
2019-12-01
Journal:
Environmental Health and Preventive Medicine
Content:
Identifiers:
DOI: 10.1186/s12199-019-0799-3
Part of ISSN: 1342-078X
Part of ISSN: 1347-4715
Authors:
Date:
2016-01-01
Journal:
Journal of Environmental and Public Health
Content:
Poor solid waste management is among the major challenges facing urban slums in developing countries including Uganda. Understanding community concerns and willingness towards involvement in solid waste management improvement initiatives is critical for informing interventions in slums.Methods. We used a cross-sectional study to collect quantitative data from 435 residents in two urban slums in central Uganda. A semistructured questionnaire was used which assessed waste collection practices, separation and disposal methods, concerns regarding solid wastes, and willingness to participate in waste separation and composting. Data was analysed using STATA 12.Results. Food remains (38%) and plastics (37%) formed the biggest proportion of wastes generated in households. Most households (35.9%) disposed of general wastes by open dumping while 27% disposed of plastics by burning. Only 8.8% of households conducted composting while 55% carried out separation for some decomposable wastes. Separation was carried out for only banana peelings and leftover foods for feeding animals. Respondents expressed high willingness to separate (76.6%) and compost (54.9%) solid wastes.Conclusion. Practices in waste disposal and separation were poor despite high willingness to participate in initiatives to improve waste management, highlighting a need for authorities to engage residents of slums to improve their practices.
Identifiers:
DOI: 10.1155/2016/6830163
Part of ISSN: 1687-9805
Part of ISSN: 1687-9813
Authors:
Date:
2022-01-02
Journal:
Malaria Journal
Content:
Abstract Background Significant progress in malaria prevention during the past two decades has prompted increasing global dialogue on malaria elimination. Recent reviews on malaria strategies have focused mainly on long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), with little emphasis on other prevention methods. This article is a scoping review of literature on malaria prevention methods beyond LLINs and IRS in low- and middle-income countries (LMICs). Methods This scoping review found articles published between from 1994 to 2020. Studies were obtained from a search of the PubMed, the Cochrane Library and Social Science abstracts. Grey literature and manual search of secondary references was also done. The search strategy included all study designs but limited only to English. Three independent reviewers performed the selection and characterization of articles, and the data collected were synthesized qualitatively. Results A total of 10,112 studies were identified among which 31 met the inclusion criteria. The results were grouped by the 3 emerging themes of: housing design; mosquito repellents; and integrated vector control. Housing design strategies included closing eves, screening of houses including windows, doors and ceilings, while mosquito repellents were mainly spatial repellents, use of repellent plants, and use of plant-based oils. Integrated vector control included larvae source management. Evidence consistently shows that improving housing design reduced mosquito entry and malaria prevalence. Spatial repellents also showed promising results in field experiments, while evidence on repellent plants is limited and still emerging. Recent literature shows that IVM has been largely ignored in recent years in many LMICs. Some malaria prevention methods such as spatial repellents and IVM are shown to have the potential to target both indoor and outdoor transmission of malaria, which are both important aspects to consider to achieve malaria elimination in LMICs. Conclusion The scoping review shows that other malaria prevention strategies beyond LLINs and IRS have increasingly become important in LMICs. These methods have a significant role in contributing to malaria elimination in endemic countries if they are adequately promoted alongside other conventional approaches.
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Date:
2021-02-12
Journal:
Journal of environmental and public health
Content:

Background

Although proper management of electronic waste (e-waste) is key to preventing disease and protecting the environment, there is no clear mechanism for its management in Uganda. This study assessed knowledge, perceptions, and practices of e-waste management among consumers in Kampala city, Uganda.

Methods

We conducted a cross-sectional study among people who used, repaired, or sold electronics (consumers). Both quantitative and qualitative methods of data collection using a sequential explanatory strategy were utilized. The quantitative survey involved 640 study participants, while qualitative interviews included 18 key informant interviews with stakeholders and six focus group discussions with 57 consumers. Modified Poisson regression was used to establish associations with corresponding 95% confidence intervals, and qualitative data analysed thematically.

Results

Two-thirds (67.7%; 433/640) of electronics consumers had poor knowledge on the management of e-waste. More than three-quarters 79.1% (506) of the consumers had positive perceptions towards e-waste management. Consumers perceived e-waste as harmful to human health and the environment. Participants in informal employment were 0.96 times less likely to have positive perceptions towards e-waste management compared to those in formal employment (adjusted PR = 0.96, 95% CI: 0.93-0.99). Mobile phones and televisions were the most owned e-waste with only 7.96% (18/226) and 13.2% (7/53) disposed off, respectively. Selling e-waste to repair shops and donation were the common disposal options.

Conclusion

Knowledge on proper e-waste management is poor among electronic consumers in Kampala, Uganda, though most have positive perceptions. There is need for increased awareness on e-waste management to prevent its effects on health and the environment. Special attention should be towards sensitisation on e-waste handling practices before disposal and final disposal options available.
Identifiers:
Authors:
David Musoke , author
Carol Namata , author
Rawlance Ndejjo , author
John C. Ssempebwa , author
Miph B. Musoke , author
Date:
2021-12-01
Journal:
Pilot and Feasibility Studies
Content:
Identifiers:
Authors:
David Musoke , author
Mathew Nyashanu , author
Henry Bugembe , author
Grace Biyinzika Lubega , author
James O’Donovan , author
Abdullah Ali Halage , author
Linda Gibson , author
Date:
2022-12-01
Journal:
Human Resources for Health
Content:
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Date:
2019-11-07
Journal:
African Health Sciences
Content:
Background: Community health workers (CHWs) continue to play a crucial role in supporting health service delivery globally. Several CHW programmes around the world face vast challenges which affect their performance.Objectives: This study assessed the performance of CHWs and associated factors in a rural community in Wakiso district, Uganda.Methods: This was a cross-sectional study that employed a structured questionnaire to collect quantitative data from 201 CHWs in Wakiso district. The main study variable was CHW performance based on various roles carried out by CHWs. Multivariable logistic regression in STATA was used to establish the predictors of CHW performance.Results: Only 40 (19.9%) of the CHWs had a high performance which was associated with having attended additional / refresher trainings [AOR=12.79 (95% CI: 1.02-159.26)], and having attained secondary level education and above [AOR=3.93 (95% CI: 1.17-13.24)]. CHWs who were married [AOR=0.29 (95% CI: 0.09-0.94)] were less likely to perform highly. Among CHWs who had received essential medicines for treatment of childhood illnesses, the majority 90.3% (112/124) had experienced stock-outs in the 6 months preceding the study. Despite the majority of CHWs, 198 (98.5%), stating that being motivated was very important in their work, only 91 (45%) said that they were motivated.Conclusion: Additional / refresher trainings are necessary to enhance performance of CHWs. In addition, level of education should be considered while selecting CHWs. The health system challenges of low motivation of CHWs as well as stock-out of medicines need to be addressed to support their work.Keywords: Community health workers, performance, motivation, satisfaction, stock-outs, village health teams, Uganda.
Identifiers:
DOI: 10.4314/ahs.v19i3.55
Part of ISSN: 1680-6905
Authors:
Date:
2011-03-01
Journal:
Journal of Hospital Infection
Content:
Identifiers:
Authors:
Diana Frost , author
Mufti Mahmud , author
M Shamim Kaiser , author
David Musoke , author
Paulette Henry , author
Shariful Islam , author
Date:
2021-12-01
Journal:
Health Policy and Technology
Content:
Identifiers:
Authors:
David Musoke , author
Rawlance Ndejjo , author
Edwinah Atusingwize , author
Charles Ssemugabo , author
Amanda Ottosson , author
Linda Gibson , author
Peter Waiswa , author
Date:
2020-08-01
Journal:
BMJ Global Health
Content:
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Date:
2020-11-25
Journal:
Nutrition Journal
Content:
Abstract Background Healthy and sustainable dietary practices offer a possible solution to competing tensions between health and environmental sustainability, particularly as global food systems transition. To encourage such dietary practices, it is imperative to understand existing dietary practices and factors influencing these dietary practices. The aim of this study was to identify multi-level factors in lived rural and urban Ugandan food environments that influence existing dietary practices among women of reproductive age (WRA). Methods A mixed methods study was conducted. Multiple correspondence analysis followed by hierarchical cluster analysis were performed on dietary data collected among a sample (n = 73) of Ugandan WRA in Kampala (urban) and Wakiso (rural) districts to elicit dietary clusters. Dietary clusters, which were labelled as dietary typologies based on environmental impact and nutrition transition considerations, were reflective of dietary practices. Following this, a smaller sample of WRA (n = 18) participated in a Photovoice exercise and in-depth interviews to identify factors in their social, physical, socio-cultural and macro-level environments influencing their enactment of the identified dietary typologies, and therefore dietary practices. Results Four dietary typologies emerged: ‘urban, low-impact, early-stage transitioners’, ‘urban, medium-impact, mid-stage transitioners’, ‘rural, low-impact, early-stage transitioners’ and ‘rural, low-impact, traditionalists’. Although experienced somewhat differently, the physical environment (access, availability and cost), social networks (parents, other family members and friends) and socio-cultural environment (dietary norms) were cross-cutting influences among both urban and rural dietary typologies. Seasonality (macro-environment) directly influenced consumption of healthier and lower environmental impact, plant-based foods among the two rural dietary typology participants, while seasonality and transportation intersected to influence consumption of healthier and lower environmental impact, plant-based foods among participants in the two urban dietary typologies. Conclusion Participants displayed a range of dietary typologies, and therefore dietary practices. Family provides an avenue through which interventions aimed at encouraging healthier and lower environmental impact dietary practices can be targeted. Home gardens, urban farming and improved transportation could address challenges in availability and access to healthier, lower environmental impact plant-based foods among urban WRA.
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Date:
2021-12-14
Journal:
African Health Sciences
Content:
Background: Timely health care among children with suspected malaria, and intermittent preventive treatment (IPTp) in pregnancy avert related morbidity and mortality in endemic regions especially in sub-Saharan Africa. Malaria burden has steadily been declining in endemic countries due to progress made in scaling up of such important interventions. Objectives: The study assessed malaria health seeking practices for children under five years of age, and IPTp in Wakiso district, Uganda. Methods: A structured questionnaire was used to collect data from 727 households. Chi-square and Fisher’s exact tests were performed in STATA to ascertain factors associated with the place where treatment for children with suspected malaria was first sought (government versus private facility) and uptake of IPTp. Results: Among caretakers of children with suspected malaria, 69.8% sought care on the day of onset of symptoms. The place where treatment was first sought for the children (government versus private) was associated with participants’ (household head or other adult) age (p < 0.001), education level (p < 0.001) and household income (p = 0.011). Among women who had a child in the five years preceding the study, 179 (63.0%) had obtained two or more IPTp doses during their last pregnancy. Uptake of two or more IPTp doses was associated with the women’s education level (p = 0.006), having heard messages about malaria through mass media (p = 0.008), knowing the recommended number of IPTp doses (p < 0.001), and knowing the drug used in IPTp (p < 0.001).  Conclusion: There is need to improve malaria health seeking practices among children and pregnant women particularly IPTp through programmes aimed at increasing awareness among the population. Keywords: Health seeking behaviour; intermittent preventive treatment; malaria; children; pregnancy; Uganda.
Identifiers:
DOI: 10.4314/ahs.v21i4.28
Part of ISSN: 1680-6905
Authors:
David Musoke , author
Luzia Helena Carvalho , editor
George Miiro , author
Rawlance Ndejjo , author
George Karani , author
Keith Morris , author
Simon Kasasa , author
Jessica Nakiyingi-Miiro , author
David Guwatudde , author
Miph Boses Musoke , author
Date:
2018-10-09
Journal:
PLOS ONE
Content:
Identifiers:
Authors:
Charles Ssemugabo , author
Sarah Nalinya , author
Grace Biyinzika Lubega , author
Rawlance Ndejjo , author
David Musoke , author
Date:
2020-12-29
Journal:
Sustainability
Content:
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Date:
2020-12-01
Journal:
Journal of Pharmaceutical Policy and Practice
Content:
Abstract Background Regulatory inspection of private drug shops in Uganda is a mandate of the Ministry of Health carried out by the National Drug Authority. This study evaluated how this mandate is being carried out at national, district, and drug shop levels. Specifically, perspectives on how the inspection is done, who does it, and challenges faced were sought from inspectors and drug sellers. Methods Six key informant interviews (KIIs) were held with inspectors at the national and district level, while eight focus group discussions (FGDs) were conducted among nursing assistants, and two FGDs were held with nurses. The study appraised current methods of inspecting drug sellers against national professional guidelines for licensing and renewal of class C drug shops in Uganda. Transcripts were managed using Atlas ti version 7 (ATLAS.ti GmbH, Berlin) data management software where the thematic content analysis was done. Results Five themes emerged from the study: authoritarian inspection, delegated inspection, licensing, training, and bribes. Under authoritarian inspection, drug sellers decried the high handedness used by inspectors when found with expired or no license at all. For delegated inspection, drug sellers said that sometimes, inspectors send health assistants and sub-county chiefs for inspection visits. This cadre of people is not recognized by law as inspectors. Inspectors trained drug sellers on how to organize their drug shops better and how to use new technologies such as rapid diagnostic tests (RDTs) in diagnosing malaria. Bribes were talked about mostly by nursing assistants who purported that inspectors were not interested in inspection per se but collecting illicit payments from them. Inspectors said that the facilitation they received from the central government were inadequate for a routine inspection. Conclusion The current method of inspecting drug sellers is harsh and instills fear among drug sellers. There is a need to establish a well-recognized structure of inspection as well as establish channels of dialogue between inspectors and drug sellers if meaningful compliance is to be achieved. The government also needs to enhance both human and financial resources if meaningful inspection of drug sellers is to take place.
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Date:
2021-10-05
Journal:
Environmental Health and Preventive Medicine
Content:
AbstractAntimicrobial resistance (AMR) is increasingly becoming a threat to global public health, not least in low- and middle-income countries (LMICs) where it is contributing to longer treatment for illnesses, use of higher generation drugs, more expenditure on antimicrobials, and increased deaths attributed to what should be treatable diseases. Some of the known causes of AMR include misuse and overuse of antimicrobials in both humans and animals, unnecessary use of antimicrobials in animals as growth promoters, and lack of awareness among the public on how to protect antimicrobials. As a result, resistant organisms are circulating in the wider environment, and there is a need to consider the One Health approach to minimise the continuing development of AMR. Environmental Health, specifically water, sanitation and hygiene (WASH), waste management, and food hygiene and safety, are key components of One Health needed to prevent the spread of antimicrobial-resistant microorganisms particularly in LMICs and reduce the AMR threat to global public health. The key Environmental Health practices in the prevention of AMR include: (1) adequate WASH through access and consumption of safe water; suitable containment, treatment and disposal of human excreta and other wastewater including from health facilities; good personal hygiene practices such as washing hands with soap at critical times to prevent the spread of resistant microorganisms, and contraction of illnesses which may require antimicrobial treatment; (2) proper disposal of solid waste, including the disposal of unused and expired antimicrobials to prevent their unnecessary exposure to microorganisms in the environment; and (3) ensuring proper food hygiene and safety practices, such as sale and consumption of animal products in which adequate antimicrobial withdrawal periods have been observed, and growing vegetables on unpolluted soil. Environmental Health is therefore crucial in the prevention of infectious diseases that would require antimicrobials, reducing the spread of resistant organisms, and exposure to antimicrobial residues in LMICs. Working with other professionals in One Health, Environmental Health Practitioners have a key role in reducing the spread of AMR including health education and promotion, surveillance, enforcement of legislation, and research.
Identifiers:
DOI: 10.1186/s12199-021-01023-2
Part of ISSN: 1342-078X
Part of ISSN: 1347-4715
Authors:
Date:
2015-01-01
Journal:
Pan African Medical Journal
Content:
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Date:
2016-12-01
Journal:
One Health
Content:
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Date:
2016-01-01
Journal:
Pan African Medical Journal
Content:
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Date:
2020-06-26
Journal:
International Journal Of Community Medicine And Public Health
Content:
Background: Soil transmitted helminthiasis, classified as neglected tropical diseases are among the most common infections worldwide with greatest numbers occurring in Sub-Saharan Africa, Americas, China and East Asia. Globally, over two billion people are infected with school-age children bearing the greatest burdens. Transmission is through eggs present in human faeces. They are infections of public health importance as they cause among others, nutritional impairment, diarrhoea and intestinal obstruction. Prevention involves deworming, health education and sanitation.Methods: The study was carried out in Rarieda, Kenya in 2018. Study participants were primary school children of ages seven to fifteen. Cross sectional study design was used and the data was analyzed using Statistical Package for Social Sciences. All the ethical issues were adhered to as per the International standards.Results: The study established that prevalence of soil transmitted helminthiasis was high in areas where the risk factors associated with the infections were high. Pupils who were more knowledgeable on soil transmitted helminthiases were less infected. Younger pupils were more infected than older pupils. Lastly, the prevalence of these infections varied with gender of the pupils, and geographical location from where the pupils came from.Conclusions: Correlation between prevalence of soil transmitted helminthiases and risk factors, and between presence of toilets and level of hygiene practice were positive, r=0.90 and 0.93 respectively; while correlation between prevalence of soil transmitted helminthiases and knowledge was negative, r=-0.75. Values of the correlations were of statistical significance at p<0.05.
Identifiers:
DOI: 10.18203/2394-6040.ijcmph20202965
Part of ISSN: 2394-6040
Part of ISSN: 2394-6032
Authors:
Date:
2020-10-01
Journal:
BMJ Global Health
Content:
Lockdown measures have been introduced worldwide to contain the transmission of COVID-19. However, the term ‘lockdown’ is not well-defined. Indeed, WHO’s reference to ‘so-called lockdown measures’ indicates the absence of a clear and universally accepted definition of the term ‘lockdown’. We propose a definition of ‘lockdown’ based on a two-by-two matrix that categorises different communicable disease measures based on whether they are compulsory or voluntary; and whether they are targeted at identifiable individuals or facilities, or whether they are applied indiscriminately to a general population or area. Using this definition, we describe the design, timing and implementation of lockdown measures in nine countries in sub-Saharan Africa: Ghana, Nigeria, South Africa, Sierra Leone, Sudan, Tanzania, Uganda, Zambia and Zimbabwe. While there were some commonalities in the implementation of lockdown across these countries, a more notable finding was the variation in the design, timing and implementation of lockdown measures. We also found that the number of reported cases is heavily dependent on the number of tests carried out, and that testing rates ranged from 2031 to 63 928 per million population up until 7 September 2020. The reported number of COVID-19 deaths per million population also varies (0.4 to 250 up until 7 September 2020), but is generally low when compared with countries in Europe and North America. While lockdown measures may have helped inhibit community transmission, the pattern and nature of the epidemic remains unclear. However, there are signs of lockdown harming health by affecting the functioning of the health system and causing social and economic disruption.
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Date:
2020-12-01
Journal:
One Health Outlook
Content:
AbstractThe interconnections of humans, domestic animals, wildlife and the environment have increasingly become complex, requiring innovative and collaborative approaches (One Health approach) for addressing global health challenges. One Health is a multidisciplinary and multi-sectoral collaborative approach to human, animal, plant and environmental health. The role of academia in training professionals oriented in One Health is critical in building a global workforce capable of enhancing synergies of various sectors in improving health.Makerere University, Uganda has implemented pre-service capacity building initiatives aimed to foster One Health competencies among students who are future practitioners. In addition to incorporating the One Health concept in didactic curricula, Student One Health Innovation Clubs, undergraduate field placements in 11 demonstration sites, graduate fellowships, small grants to support research and innovations, and cross-college collaborative training approaches have greatly aided the assimilation of One Health into the fabric of university offerings. Partnerships with government ministries, private sector and international agencies were initiated to benefit the students, as well as chart a path for experiential learning and in-service offerings in the future.One major challenge, however, has been the tendency to focus on infectious diseases, especially zoonoses, with less consideration of other health issues. The opportunity for improvement, nonetheless, lies in the increasing emerging and re-emerging health concerns including epidemics, environmental pollution and related challenges which justify the need for countries and institutions to focus on building and strengthening multidisciplinary health systems.
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Date:
2020-12-14
Journal:
The American Journal of Tropical Medicine and Hygiene
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DOI: 10.4269/ajtmh.20-1174
Part of ISSN: 0002-9637
Part of ISSN: 1476-1645
Authors:
David Musoke , author
Rawlance Ndejjo , author
Abdullah Ali Halage , author
Simon Kasasa , author
John C. Ssempebwa , author
David O. Carpenter , author
Date:
2018-01-01
Journal:
Journal of Environmental and Public Health
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Date:
2021-10-01
Journal:
Health Research Policy and Systems
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Abstract Background Community health worker (CHW) programmes are again receiving more attention in global health, as reflected in important recent WHO guidance. However, there is a risk that current CHW programme efforts may result in disappointing performance if those promoting and delivering them fail to learn from past efforts. This is the first of a series of 11 articles for a supplement entitled “Community Health Workers at the Dawn of a New Era”. Methods Drawing on lessons from case studies of large well-established CHW programmes, published literature, and the authors’ experience, the paper highlights major issues that need to be acknowledged to design and deliver effective CHW programmes at large scale. The paper also serves as an introduction to a set of articles addressing these issues in detail. Results The article highlights the diversity and complexity of CHW programmes, and offers insights to programme planners, policymakers, donors, and others to inform development of more effective programmes. The article proposes that be understood as actors within community health system(s) and examines five tensions confronting large-scale CHW programmes; the first two tensions concern the role of the CHW, and the remaining three, broader strategic issues: What kind of an actor is the CHW? A lackey or a liberator? Provider of clinical services or health promoter? Lay versus professional? Government programme at scale or nongovernmental organization-led demonstration project? Standardized versus tailored to context? Vertical versus horizontal? Conclusion CHWs can play a vital role in primary healthcare, but multiple conditions need to be met for them to reach their full potential.
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Date:
2015-01-01
Journal:
Journal of Environmental and Public Health
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Objective.To assess the occupational health hazards faced by healthcare workers and the mitigation measures.Methods.We conducted a cross-sectional study utilizing quantitative data collection methods among 200 respondents who worked in 8 major health facilities in Kampala.Results.Overall, 50.0% of respondents reported experiencing an occupational health hazard. Among these, 39.5% experienced biological hazards while 31.5% experienced nonbiological hazards. Predictors for experiencing hazards included not wearing the necessary personal protective equipment (PPE), working overtime, job related pressures, and working in multiple health facilities. Control measures to mitigate hazards were availing separate areas and containers to store medical waste and provision of safety tools and equipment.Conclusion.Healthcare workers in this setting experience several hazards in their workplaces. Associated factors include not wearing all necessary protective equipment, working overtime, experiencing work related pressures, and working in multiple facilities. Interventions should be instituted to mitigate the hazards. Specifically PPE supply gaps, job related pressures, and complacence in adhering to mitigation measures should be addressed.
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DOI: 10.1155/2015/913741
Part of ISSN: 1687-9805
Part of ISSN: 1687-9813
Authors:
Moses Mukuru , author
Jonathan Gorry , author
Suzanne N. Kiwanuka , author
Linda Gibson , author
David Musoke , author
Freddie Ssengooba , author
Date:
2021-09-07
Journal:
International Journal of Health Policy and Management
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Date:
2015-01-01
Journal:
Journal of Environmental and Public Health
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Objective. To assess the bacteriological and physical quality of locally packaged drinking water sold for public consumption.Methods. This was cross-sectional study where a total of 60 samples of bottled water from 10 brands and 30 samples of sachet water from 15 brands purchased randomly were analyzed for bacteriological contamination (total coliform and faecal coliform per 100 mL) using membrane filtrate method and reported in terms of cfu/100 mL.Results. Both bottled water and sachet water were not contaminated with faecal coliform. Majority (70%, 21/30) of the sachet water analyzed exceeded acceptable limits of 0 total coliforms per 100 mL set by WHO and the national drinking water standards. The physical quality (turbidity and pH) of all the packaged water brands analyzed was within the acceptable limits. There was statistically significant difference between the median count of total coliform in both sachet water and bottled water brands (U(24)=37.0,p=0.027).Conclusion. Both bottled water and sachet water were not contaminated with faecal coliforms; majority of sachet water was contaminated with total coliform above acceptable limits. Government and other stakeholders should consider intensifying surveillance activities and enforcing strict hygienic measures in this rapidly expanding industry to improve packaged water quality.
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DOI: 10.1155/2015/942928
Part of ISSN: 1687-9805
Part of ISSN: 1687-9813
Authors:
David Musoke , author
Charles Ssemugabo , author
Rawlance Ndejjo , author
Sassy Molyneux , author
Elizabeth Ekirapa-Kiracho , author
Date:
2020-12-01
Journal:
BMC Medical Ethics
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Date:
2021-12-01
Journal:
Malaria Journal
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Abstract Background Consistent use of insecticide-treated nets (ITNs) and intermittent preventive treatment in pregnancy (IPTp) have been recommended as cost-effective interventions for malaria prevention during pregnancy in endemic areas. However, the coverage and utilization of these interventions during pregnancy in sub-Saharan Africa is still suboptimal. This study aimed to determine the uptake of IPTp and ITNs and associated factors among women during their recent pregnancy in Eastern Uganda. Methods This was a cross-sectional study conducted among 2062 women who had delivered within the last 12 months prior to the start of the study in three districts of Eastern Uganda. The primary outcomes were consistent ITN use and optimal uptake (at least 3 doses) of IPTp. A modified Poisson regression was used to examine the association between consistent ITN use and the uptake of optimal doses of IPTp with independent variables. Data were analysed using Stata 14 software. Results The level of uptake of IPTp3 (at least three doses) was 14.7%, while IPTp2 (at least two doses) was 60.0%. The majority (86.4%) of mothers reported regularly sleeping under mosquito nets for the full duration of pregnancy. Uptake of IPTp3 was associated with engaging in farming (adjusted PR = 1.71, 95% CI [1.28–2.28]) or business (adjusted PR = 1.60, 95% CI [1.05–2.44]), and attending at least 4 antenatal care (ANC) visits (adjusted PR = 1.72, 95% CI [1.34–2.22]). On the other hand, consistent ITN use was associated with belonging to the fourth wealth quintile (adjusted PR = 1.08, 95% CI [1.02–1.14]) or fifth wealth quintile (adjusted PR = 1.08, 95% CI [1.02–1.15]), and attending at least 4 ANC visits (adjusted PR = 1.07, 95% CI [1.03–1.11]). Conclusion Uptake of IPTp3 and consistent ITN use during pregnancy were lower and higher than the current Ugandan national targets, respectively. Study findings highlight the need for more efforts to enhance utilization of ANC services, which is likely to increase the uptake of these two key malaria preventive measures during pregnancy.
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Date:
2015-01-01
Journal:
Reproductive Health Matters
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DOI: 10.1016/j.rhm.2015.06.011
Part of ISSN: 0968-8080
Part of ISSN: 1460-9576
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Date:
2019-08-31
Journal:
International Journal of TROPICAL DISEASE & Health
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Soil Transmitted Helminthiases (STH) are a group of chronic infections, typically very common or endemic in low income countries and are classified as Neglected Tropical Diseases (NTD). Despite the World Health Organization (WHO) laid down control strategies and goal to eradicate these infections by the year 2020, these infections continue to dominate in Sub-Saharan countries; this problem necessitated the need for this study. The primary objective of this study was to assess prevalence of, and risk factors of STH among primary school children in Rarieda, a sub-county in Siaya County of Kenya. The study contributed to the overall theme of “Research for Better Health in East African Region”. The study population comprised of primary school children, aged between seven and fifteen years. A total sample size of 300 pupils was randomly sampled from five primary schools across Rarieda. Data were collected between September and October 2018 and cross sectional study design was used. Ethical approvals were obtained from all the relevant authorities and pre-testing was done at Ruma primary school. Data was collected using structured questionnaires, Key Performance Indicators (KII) and Focused Group Discussions (FGD). The study established that there was high prevalence of STH among the primary school children in Rarieda, with prevalence rate of 27.3 percent. The prevalence rate varied with socio-demographic characteristics of the pupils. Knowledge level of the pupils on STH was 38.9, and the pupils were 45.9 percent at risk of STH with a great variance noted between health practices at schools verses at homes. Integrated STH control approach, which would incorporate regular deworming, health education and promotion, hygiene and sanitation, and appropriate health policies formulation and implementations, was therefore seen to be very necessary in controlling and prevention of STH in Rarieda.
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Date:
2021-12-31
Journal:
Global Health: Science and Practice
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DOI: 10.9745/ghsp-d-21-00260
Part of ISSN: 2169-575X
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Date:
2020-06-01
Journal:
Journal of Water, Sanitation and Hygiene for Development
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Abstract We explored the facilitators and barriers to uptake of water, sanitation and hygiene (WASH) interventions among slum dwellers in Kampala, Uganda using a socio-ecological perspective. This qualitative exploration used focus group discussions with community members and key informant interviews with community leaders and technocrats to collect data. Among facilitators to uptake of WASH interventions were susceptibility to WASH-related diseases and low WASH knowledge levels at individual level, peer practices at household level, and promotion of WASH at organizational level. At community and public policy levels, community engagement and empowerment, and formation and enforcement of ordinances and bye-laws, respectively, motivated slums dwellers to adopt WASH interventions. Conversely, individual knowledge, beliefs, language, and financial status inhibited individuals from taking up WASH interventions. Negative peer practices and upbringing at peer level; unsupportive environments, and engagement of communities at organizational level; cultural beliefs and lack of space at community level; and unexamplary leaders and political interference barred slum dwellers in Kampala from embracing the WASH interventions. Uptake of WASH interventions in the slum community is influenced by a cascade of facilitators and barriers across the socio-ecological realm. Hence, a multi-faceted approach targeting all stakeholders is required in planning and implementation of WASH interventions.
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DOI: 10.2166/washdev.2020.124
Part of ISSN: 2043-9083
Part of ISSN: 2408-9362
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Date:
2021-10-01
Journal:
Health Research Policy and Systems
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Abstract Background While the evidence supporting the effectiveness of community health worker (CHW) programmes is substantial, there is also considerable evidence that many of these programmes have notable weaknesses that need to be addressed in order for them to reach their full potential. Thus, considerations about CHW programme performance and its assessment must be taken into account as the importance of these programmes is becoming more widely appreciated. In this paper, the tenth in our 11-paper series, “Community health workers at the dawn of a new era”, we address CHW programme performance and how it is assessed from a systems perspective. Methods The paper builds on the 2014 CHW Reference Guide, a compendium of case studies of 29 national CHW programmes, the 2018 WHO guideline on health policy and system support to optimize CHW programmes, and scientific studies on CHW programme performance published in the past 5 years. Results The paper provides an overview of existing frameworks that are useful for assessing the performance of CHW programmes, with a specific focus on how individual CHW performance and community-level outcomes can be measured. The paper also reviews approaches that have been taken to assess CHW programme performance, from programme monitoring using the routine health information system to national assessments using quantitative and/or qualitative study designs and assessment checklists. The paper also discusses contextual factors that influence CHW programme performance, and reflects upon gaps and needs for the future with regard to assessment of CHW programme performance. Conclusion Assessments of CHW programme performance can have various approaches and foci according to the programme and its context. Given the fact that CHW programmes are complex entities and part of health systems, their assessment ideally needs to be based on data derived from a mix of reliable sources. Assessments should be focused not only on effectiveness (what works) but also on contextual factors and enablers (how, for whom, under what circumstances). Investment in performance assessment is instrumental for continually innovating, upgrading, and improving CHW programmes at scale. Now is the time for new efforts in implementation research for strengthening CHW programming.
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Date:
2020-01-01
Journal:
Journal of Epidemiology and Global Health
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Date:
2020-03-31
Journal:
International Health
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Abstract Background This study assessed characteristics of sanitation and hygiene facilities in a slum community in Kampala, Uganda. Methods We conducted a household-based cross-sectional study among 395 households in Kasubi slum using a semi-structured questionnaire and observational checklist to collect data. Results Almost 98.0% (387/395) of households owned a sanitation facility and 77.0% (298/387) shared it with other households. The most common type of sanitation facility was a pit latrine with slab (66.9% [259/387]). Most (90.5% [305/337]) latrines had a door or shutter, a roof (92.9% [313/337]) and a depth &gt;1.5 m (68.2% [229/337]). Overall, 21.3% (84/395) and 65.6% (259/395) of households had improved and functional sanitation facilities, respectively. Only 16.5% (65/395) of the households had a hand-washing facility. Student-led (adjusted prevalence rate [PR] 2.67 [95% confidence interval [CI] 1.83–3.94]) and households that owned their house (adjusted PR 2.17 [95% CI 1.33–3.53]) were 2.67 and 2.17 times more likely to have improved sanitation facilities, respectively. Households that owned their house (adjusted PR 1.90 [95% CI 1.18–3.05]) were 1.9 times more likely to possess a hand-washing facility. Conclusions The coverage of improved sanitation and hygiene facilities was low. The majority of households were using a shared pit latrine with a slab that had no hand-washing facility. Sanitation and hygiene interventions should prioritize improving sanitation and hygiene facilities.
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DOI: 10.1093/inthealth/ihaa011
Part of ISSN: 1876-3413
Part of ISSN: 1876-3405
Authors:
Charles Ssemugabo , author
Solomon Tsebeni Wafula , author
Grace Biyinzika Lubega , author
Rawlance Ndejjo , author
Jimmy Osuret , author
Abdullah Ali Halage , author
David Musoke , author
Date:
2020-05-06
Journal:
Journal of Environmental and Public Health
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Authors:
Tracy Morse , author
Kondwani Chidziwisano , author
David Musoke , author
Tara K Beattie , author
Selva Mudaly , author
Date:
2020-07-01
Journal:
BMJ Global Health
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Date:
2018-12-01
Journal:
Health Research Policy and Systems
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Date:
2020-10-31
Journal:
Antibiotics
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Antimicrobial stewardship (AMS), as one of the global strategies to promote responsible use of antimicrobials to prevent antimicrobial resistance (AMR), remains poor in many low-and middle-income countries (LMICs). We implemented a project aimed at strengthening AMS in Wakiso district, Uganda using a One Health approach. A total of 86 health practitioners (HPs), including animal health workers, and 227 community health workers (CHWs) participated in training workshops, and over 300 pupils from primary schools were sensitized on AMR, AMS, and infection prevention and control (IPC). We further established two multidisciplinary online communities of practice (CoPs) for health professionals and students, with a current membership of 321 and 162, respectively. In addition, a Medicine and Therapeutics Committee (MTC) was set up at Entebbe Regional Referral Hospital. The project evaluation, conducted three months after training, revealed that the majority of the HPs (92.2%) and CHWs (90.3%) reported enhanced practices, including improved hand washing (57.3% and 81.0%, respectively). In addition, 51.5% of the HPs reported a reduction in the quantity of unnecessary antibiotics given per patient. This project demonstrates that AMS interventions using a One Health approach can promote understanding of the prudent use of antimicrobials and improve practices at health facilities and in communities.
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Date:
2021-10-01
Journal:
Health Research Policy and Systems
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Abstract Background Supervision is essential for optimizing performance and motivation of community health workers (CHWs). This paper, the seventh in our series, “Community health workers at the dawn of a new era”, supplements the existing evidence on CHW supervision in low- and middle-income countries by reviewing what supervision approaches are employed in specific contexts, identifying potential facilitators of CHW supervision including mobile health (mHealth) interventions, and noting challenges of supervision including the relationship between supervision and other CHW programme elements. Methods For this exploratory research study on CHW supervision, we reviewed the supervisory interventions described in a compendium of 29 case studies of large-scale CHW programmes, performed an electronic search of multiple databases to identify articles related to CHW supervision published between 15 June 2017 and 1 December 2020, and from those articles followed additional references that appeared to be relevant for our results. Results We reviewed 55 case studies, academic articles, and grey literature resources as part of this exploratory research. A variety of supervision approaches have been adapted over time, which we grouped into five categories: external supervision, community supervision, group supervision, peer supervision, and dedicated supervision. These approaches are frequently used in combination. Digital (mHealth) technologies are being explored as potential facilitators of CHW supervision in both small- and large-scale programmes; however, evidence of their effectiveness remains limited to date. Inadequate support for supervisors is a major challenge, particularly given the numerous and varied roles they are expected to fulfil, spanning administrative, clinical, and supportive activities. Supervisors can help CHWs acquire other critical elements needed from the health system for them to perform more effectively: incentives to foster motivation, clarity of roles and tasks, adequate tools and supplies, appropriate knowledge and skills, and a safe work environment. Conclusion In the absence of a universal “best approach” for CHW supervision, our recommendation is that countries and programmes prioritize homegrown evolution over time to suit the local context. In some cases, this may involve scaling up novel approaches that have proven effective at small scale or testing approaches that have worked in other countries.
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Date:
2015-01-16
Journal:
African Health Sciences
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DOI: 10.4314/ahs.v14i4.36
Part of ISSN: 1680-6905
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Date:
2019-03-04
Journal:
Archives of Environmental & Occupational Health
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DOI: 10.1080/19338244.2018.1541858
Part of ISSN: 1933-8244
Part of ISSN: 2154-4700
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Date:
2017-09-01
Journal:
BMC Proceedings
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