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Knowledge and Practices of Health Workers Towards Injuries due to Sharps in Health Facilitities and Access to HIV Post Exposure Prophylaxis in Nakaseke District, Uganda.
(International Health Sciences University, 2010-09) Ddamulira, Christopher
The study aimed at assessing health workers knowledge and practices related to sharp injury prevention, and access to post exposure prophylaxis against HIV, so as to generate information that will be used by the DHT to strengthen occupational HIV exposure control programs in health units. In Uganda, there is a high prevalence of sharp object injuries (57%) among health workers (M.O.H, 2003). 82.9% of the health workers in Semuto Health Centre IV in Nakaseke district had been exposed to potentially infectious fluids, this was mostly after percutenious injury and only 16.7% of these sought advice for PEP, despite the services being available in the two hospitals within the district (Nakaseke District HIV Monitoring and Evaluation Report, 2009). The study was carried out in Nakaseke district on facility based health workers offering clinical care; cleaners were included, because their work involves handling and disposing of used infectious sharp objects. The study was conducted between July and August 2011. It was a cross-sectional study that employed both quantitative and qualitative methods of data collection. Quantitative data was analyzed using EpiInfo 3.3 version and Microsoft Excel 2007 statistical packages. Univariate, Bivariate and Multivariate levels of data analysis techniques were applied. The major findings of the study were: Over fifty six percent (56.2%) of health workers in Nakaseke district had ever experienced sharp injuries; most of the health workers that experienced sharp injuries (66.1%) were nurses/midwives, followed by nursing assistants (61.0%). The majority of health workers (91.8%) who were injured did not seek PEP despite the ART and PEP of HIV services being available in the two hospitals in the district. Nurses/midwives and nursing assistants were respectively found to be 4.3 and 19.6 times respectively more likely to be injured by sharps compared to medical officers, and the commonest types of sharp related injuries (76.0%) were caused by needle stick and they occurred mainly when giving an injection (39.0%) followed by putting up an IV line (25.8%). Basing on the findings, the study recommended: Disseminate information regarding prevention of needle stick injuries and appropriate action following a high HIV risk needle stick injuries by HIV/AIDS specialists; and the emphasis should be in terms of risk management, teaching and continuing professional education. The Ministry of Health through the office of the District Health Officer should build the capacity of health centre IIIs and IVs in the districts to offer post exposure prophylaxis of HIV in order to increase the up take of PEP by health workers after exposure to high HIV risk needle stick injuries. The District Health Officer-Nakaseke should ensure that policies are in place on exposure control and PEP against HIV procedures are in all health units in the district to reduce the risk of occupational exposure to sharp injuries and increase up take of PEP against HIV. Further research to assess the impact of HIV infection among health workers as result of injuries due to sharps is recommended.
Depression,Anxiety and Self Esteem in Relation with Sleep Patterns Among Teenage Students :
(International Health Sciences University, 2010-09) Ssesanga, Denis Ernest
The purpose of this study was to investigate depression,anxiety and self esteem in relation with sleep patterns among teenage students. A total of 100 teenage students were selected to take part in this study. It was carried out at two schools namely; Green Hill Academy and Muyenga High School. Teenage students who are depressed may show loss of interest, feelings of low self worth, have disturbed sleep and poor concentration. The study inculcates all those in authority, parents and concerned citizens about why we should be concerned about the teenage students´ sleep patterns. We should know that sleep affects a teenage student´s depression,anxiety and self esteem. Eighty seven percent slept less than the recommended 8 hours per night while sixty eight percent slept for less than six hours per night on average seven percent of the students probably had severe depression. Fifty percent of students probably had very low anxiety compared to fifteen percent who had severe anxiety. Eighty seven percent of the students had very good self esteem compared to the thirteen percent who had low levels. The null hypothesis that stated that there was no significant relationship between self esteem and sleep patterns was rejected thus concluding that there is significant relationship between self esteem and sleep patterns among teenage students. Looking at how many students had moderate scores, on all the variables especially for sleep patterns and depression, there is a possibility that in the next ten years, the majority of students will have severe conditions if no precautions are undertaken by those in authority.
Injury Morbidity Patterns, Risk Factors and Facilities Attended After Injury in Makindye Division Kampala
(International Health Sciences University, 2011-08) Aboka, Willy Were
Background: There is paucity of injury-related data in Uganda. We conducted a population-based survey on injuries in Namuwongo suburb of Kampala. Objectives: We assessed the patterns of injuries that were sustained among Namuwongo communities between April and September of 2011, the associated factors and facilities that were attended for care. Methods: In a cross-sectional survey quantitative data from 144 households were collected using a questionnaire. Qualitative data were collected by focus group discussions in 3 of 6 participating zones and key informant interviews with community leaders and health facility managers. Results: Ninety-three injuries were reported among 653 subjects in 6 months. Major causes of injuries were road traffic accidents—RTA (24%), cuts (22%) and falls (17%). The mean age of injured people was 33 years (S.D. 12, range 0-67 years), males were more likely to get injured than females (OR: 1.69 CI: 1.05-2.7). 22% of subjects who reported injuries were housewives, 20% were students and 12% were motorcycle riders. Most injuries occurred in the home (54%), roads (27%) and schools (7%). Only 4% of subjects who sought care reported to the local public health facility; 96% sought care at private clinics and hospitals. There were no community-based injury services. Conclusions: RTA, falls and cuts were the commonest injury causes. Males and some occupations were more affected than others. Kampala City Authority needs to improve injury care services at peripheral units and in communities. A division-wide injury survey including cost analysis would inform policy development and advocacy for injury services. Number of words: 249. Key words: Injuries, Population-based, Uganda
Factors Influencing the Prevalence of Gender Based Violence Among Married Women in West Budama County, Tororo District.
(International Health Sciences University, 2011-09) Lynette, Opendi
The study sought to determine factors influencing the prevalence of gender based violence among married women in West Budama County, Tororo District. This was a descriptive cross sectional study. Cluster sampling was used for the quantitative study while purposive sampling was employed for the qualitative study. Pre-tested questionnaires and interview guides were used for data collection. The study was carried out between August and September 2011. The study found that the prevalence of GBV among married women in West Budama County was 85.4%. The types of GBV suffered by the married women include physical (about 29.9%), psychological abuse (about 30%) and sexual abuse (about 40%). Socio-demographic factors influencing GBV among married women was age, low education level, religion and occupation. Other factors influencing GBV among married women in West Budama County, Tororo include polygamy, alcohol and substance abuse, cultural practises such as the payment of bride price and widow inheritance. In conclusion, the prevalence of GBV among married women in West Budama County, Tororo District is high. The types of GBV suffered by the women are physical, sexual and psychological abuse. Factors influencing GBV are low education level, polygamy, alcohol and substance abuse, cultural practises like the payment of bride price and widow inheritance among others. The practise of payment of bride price and its influence on GBV needs to be researched among a bigger study population that includes even men. Further studies on GBV should be analytical to provide information on which variables predict GBV among married women.
Performance of Village Health Teams :
(International Health Sciences University, 2011-09) Adoa, John Steven
This study was about establishing the factors that influence the performance of Village Health Teams in Soroti District. The main objective of the study was to establish factors that influence the performance of the Village Health Teams in Soroti and to suggest measures that can be used to address these factors. The specific objectives of the study were: To examine the current motivational factors for the VHTs in Soroti District, to assess the current educational levels of VHTs in the District, to assess the current levels of skills and knowledge among VHTs in the District, to assess the level of training of VHTs and to assess the level of support supervision and mentoring of VHTs by the District and sub county health officials and also assess the level of performance of VHTs in Soroti District. Methodology: This was a cross sectional survey carried out in the District of Soroti covering the seven sub counties and the study sample population size was 175. Results: The study findings revealed that lack of motivation (provision of incentives), inadequate support supervision and lack of transport were identified as the key factors influencing the performance of VHTs in Soroti District. Conclusion: The study concluded that lack of motivation; support supervision and mentoring and inadequate transport have a significant influence on the performance of the VHTs in Soroti District. Recommendation: The study recommends implementation of a sustainable motivation mechanism, provision of regular support supervision and mentoring and provision of transport to VHTs as among the important measures that should be put in place to improve on their performance and consequently contribute to improvement of the health services delivery in Soroti District by the VHTs. And also further studies should be conducted on community’s attitudes and perceptions.
A study of Factors Affecting Cervical Cancer Screening Uptake Among Women Aged 20 to 60 Years.
(International Health Sciences University, 2011-09) Arineitwe, Ronald Kibonire
This study was done in Hoima district to determine the socio-demographic, clients’ and institutional factors affecting cervical cancer screening uptake among women aged 20 to 60 years so as to improve early detection as a way of reducing morbidity and mortality associated with this disease. The research questions that guided the study were as follows: What are socio-demographic factors affecting cervical cancer screening uptake among women in the age group of 20-60 years in Hoima district? What are the clients’ factors affecting the uptake of cervical cancer screening services among women in the age group of 20-60 years? What are the institutional factors affecting cervical cancer screening uptake among women of the age group 20 to 60 years? The study population consisted of 400 women aged between 20 to 60 years and 95 health workers as key informants from Hoima district from the 20 selected health centre III, IV and a Hospital. A cross-sectional study with quantitative method was carried out using interviewer administered semi-structured questionnaires. The key study findings were that socio-demographic such as age and marital status and occupation affect the uptake of cervical cancer screening in Hoima while the only clients’ factor that was significant was being told about the importance of cervical cancer screening. Availability of cervical cancer screening services were also found to be very limited only to one health facility(Reproductive Health Uganda Health centre) in the whole district and the uptake of screening services were generally low at only (3%) which is surprising considering how deadly this disease is . The study recommended the introduction of health promotion campaigns specific for cervical cancer emphasizing the importance of screening. It also recommended the introduction of cervical cancer screening services in all health centre 111s, IVs and a Hospital after training of at least two health workers (any of these: Nurses, midwives, clinical officers and doctors) from each of these health in Hoima district and equipping of these health facilities with acetic acid for screening since it is assumed that the other required equipments are already available.
Prevalence and Factors Associated with Adherence to Clinic Appointments of HIV Positive Patients Attending Joint Clinical Research Centre-Lubowa, Wakiso District.
(International Health Sciences University, 2011-09) Twikirize, Maureen
HIV/AIDS is still a serious problem world over. Many HIV positive people worldwide have been started on highly active anti-retroviral treatment (HAART) which has improved the quality of life. Although HAART has improved the quality of life and reduced the incidence of AIDS defining illnesses, some patients gradually stop honouring clinic appointments. A crossectional study to determine prevalence and factors associated with adherence to clinic appointments was done at JCRC –Lubowa,Wakiso district. The number of participants interviewed was 377, 64.2% were female, while 35.8% were male of mean age 41.9 years (SD=9.51), age range of 20 -75years. Objective: To determine the prevalence and factors associated with adherence to clinic appointments among patients attending JCRC adult OPD clinic. Methods: The study design was crossectional, and quantitative in nature. Structured questionnaires and interviews were used in collecting data, from HIV positive patients who had attended JCRC in the last one year. Other data like CD4 count was obtained from the Patient Care Research Database. Results: The proportion of JCRC patients who have missed schedule appointments in the last one year is 37.14%. Majority 94(25.07%) had missed at least one scheduled visit, while 28(7.47%) had missed more than three visits in the last one year. The prevalence of bad adherence to clinic appointments at Joint clinical Research Centre was found to be 37%, while that of good adherence was at 62.7% in patients who have been attending JCRC adult out patient clinic in the last one year. Factors associated with adherence to clinic appointment were; fair quality of health services at JCRC, current performance scale of between I –II, current CD4 count of greater than 350cells/microlitre, a higher level of education (Secondary and university level) and means of transport. Significance of the study: Conducting this study has helped to determine the prevalence and factors such as means of transport, performance scale level, and quality of health care that are associated with adherence to clinic appointments in HIV positive patients Also from the information obtained, simple, efficient and replicable ways of assessing and maintaining good adherence to clinic appointments may be designed.
Determination of Knowledge, Attitude and Perception of Employers and Employees Towards the Proposed National Health Insurance Scheme in the Central Region - Kampala District.
(International Health Sciences University, 2011-09) Mugisha, William
Introduction. The purpose of this research was to determine the employers and employee’s Knowledge, Attitude and Perception towards the proposed National Health Insurance Scheme in Uganda. The major research objective was to determine the level of knowledge, attitude and perception of employers and employees in the private sector on National Health Insurance Scheme in Uganda. The specific objectives of the research were; to determine the level of employers and employees knowledge on proposed National Health Insurance Scheme, to establish the attitude of employers and employees towards the proposed National Health Insurance Scheme and to establish the employers and employees perception of the proposed National Health Insurance Scheme Methodology A cross section survey research design was used with both quantitative and qualitative data collected using a sample size of 384 respondents. Research findings Findings indicate that there is lack of adequate information to employers and employees and those with a clue about NHIS had inadequate information and with total lack of what the Scheme is to offer. Further, majority responded that whereas the idea is good, the poor services in government hospitals and the existing corruption in the country may not allow delivery of quality health care.That there is need to first eliminate all the corrupt officials, put in place all the required equipments, motivate health workers and then implement the new scheme- NHIS. Recommendations Basing on the findings the study recommends that the government carries out an aggressively tailored sensitization/ promotional program that is geared towards enhancing employee and employers’ knowledge, attitude and perceptions towards NHIS. Further studies should be done to establish facility level of readiness to provide the service for NHIS.
Assessment of Knowledge, Attitudes and Practices of Care Takers of Epilepsy Patients in Burera District, Rwanda.
(International Health Sciences University, 2011-09) Leonce, Byimana
Objective: Burera district has suffered from a high prevalence of epilepsy and the people with epilepsy experience inadequate social and medical treatment. The objective in this study was to assessment of knowledge, attitudes and practices of care takers of epilepsy patients in Burera district, Rwanda. Methods: Care takers in rural district of Rwanda (Burera) completed a self- administered, 35-item questionnaire containing items addressing personal experience with epilepsy, social tolerance, and willingness to provide care, epilepsy care knowledge, and estimates of others’ attitudes. Analyses were conducted to assess characteristics associated with epilepsy management in the community. Results: With respect to how others view people with epilepsy, care takers indicated that among their family members, people with epilepsy are usually feared (48.1%) or rejected (26.9%), with only 20% of care takers reporting that people with epilepsy are accepted. Care takers viewed the community as even less supportive of people with epilepsy, reporting that the community rejects or fears people with epilepsy 49.8 and 39.0%, respectively. Only 7% of care takers feel that people with epilepsy are accepted by their community. Then, the management of epilepsy in the community is negative, as many children with epilepsy cannot be taken to school and adult people cannot find a job, what increase their bad leaving conditions. Conclusions—Knowledge gaps exist in the community on the causes of mismanagement of epilepsy. Care takers expressed both personal and professional reservations about people with epilepsy marrying, studying, and working. This reflects the conditions in which people with epilepsy are put in and more information about epilepsy should be provided to all categories of people.
The Effect of Stigma on Health Seeking Behavior, Adherence to ART and Disclosure of HIV Sero-Status :
(International Health Sciences University, 2011-09) Githongo, Fredrick
Stigma and discrimination is a major obstacle and significant challenge to the success of achieving universal access to HIV prevention, treatment, care and support. The study examined how perceived HIV-related stigma tends to create a “hidden epidemic” of the disease based on socially-shared ignorance, fear, misinformation, and denial. The purpose of this research was to establish the effect of stigma on health seeking behaviour, adherence to ART and disclosure of HIV serostatus. The objectives of the study were 1) to understand the types of stigma that people living with HIV face in Kaloleni district at the Coast Province of Kenya, 2) to determine the effects of stigma on health-seeking behaviour, 3) to establish the effects of stigma on adherence to ART and 4) to identify the effects of stigma on disclosure of HIV serostatus. The null hypotheses’ were: H01: HIV positive-related stigma has no significant effect on adherence to ART and H02: HIV positive-related stigma has no significant effect on disclosure of HIV among PLWHIV. Study design & Methodology: A combination of a cross-sectional study design and a prospective case-series design was used. In this study, 40% of participants were randomly selected from clients accessing some intervention. The research introduced scales that quantify individuals’ reasons for HIV disclosure and adherence. The instruments used were questionnaires and an observation checklist. Quantitative data collected was cleaned coded and entered into an SPSS programme for analysis. Qualitative data was put under themes consistent with the research objectives. The statistical analysis (chi-square) was used to compare socio-demographic characteristics and selected variables between the groups, and to test the hypotheses of the study. Results/Findings: The study established the existence of AIDS-related stigma. In this study majority of respondents had high levels of internal stigma as compared to external stigma. The study established that the People Living with HIV who had high internal and external levels of stigma did not adhere to ARTs. The chi-square test revealed that stigma had an effect on ART adherence and disclosure of serostatus and p-value was =0.05 which was statistically significant. Therefore, the null hypothesis was rejected and the alternate hypothesis accepted. Conclusion: The study findings revealed that stigma negatively affects PLWHIV health-seeking behaviour where the majority did not adhere to ARTs. The findings explored types of stigma and endorsement of various reasons against disclosing. It can be concluded that people living with HIV/AIDS suffer internal and external discrimination. As a result, they do not seek proper medical attention in time despite free drugs availability. Recommendations: Although stigma is considered a major barrier to effective responses to the HIV/AIDS epidemic the complexity of HIV/AIDS related stigma is often cited as a primary reason for the limited response to this pervasive phenomenon. Relevant recommendations have been given to policy makers and health facilities administrators. This study therefore recommends. The media and medics should strive to educate the public on how to treat people with HIV/AIDS and to stop discrimination and stigmatization of such people. PLWHIVs should be counseled sufficiently after knowing their status and should also be followed up on to see how they are progressing with their condition.
The Factors Influencing the Health Promotional Role of Nurses Against Cervical Cancer in Jinja Regional Referral Hospital.
(International Health Sciences University, 2011-09) Nabbowa, Juliet Businge
Introduction: Cervical Cancer is one of the preventable cancers in Uganda with a crude incidence rate of 22.6 per 100,000 population, and 2,464 deaths per year. Eighty percent of the clients report late a situation which can be averted by the nurses if they played their health promotional role against cervical cancer. General Objectives: The main objective of the study was to investigate the factors that influence the nurses’ health promotional role against cancer of the cervix in Jinja Regional Referral Hospital. Methodology: The study was carried among 154 nurses in Jinja Regional Referral Hospital using a cross sectional design. Participants for quantitative and qualitative study were selected using the consecutive and purposive sampling methods respectively. Data was collected on nurses' socio-demographic factors, health system factors, and nurses’ attitudes towards health promotional roles against cancer of cervix using a pre-tested questionnaires and interview guides. Quantitative data was entered in the Epidata and analysed by SPSS software package version 10.0. Qualitative data was analysed by thematic analysis of the response to identify the emerging themes for presentation of results. Results: Nurses with less than nine years of work experience (OR = 2.32, P = 0.011), nurses with salary scale U3-U4 (OR = 10.51, P = 0.027), nurses without a job description (OR = 5.56, P = <0.001) and nurses who follow-up of cancer patient (OR = 7.2, P = 0.001) were more likely to be involved in health promotional activities against cancer of cervix. Overall nurses were less involved in health promotional activities against cancer of cervix. Nurses with negative attitudes towards their health promotional role against cervical cancer (OR = 0.52, P = 0.048), clients involvement (OR = 0.45, P = 0.016) and health promotion as a concept (OR = 0.38, P = 0.004) were less likely to get involved in health promotion against cancer of the cervix. Conclusion: Overall nurses were less involved in health promotional activities against cancer of cervix. Generally nurses in Jinja Regional Referral Hospital had a positive attitude towards health promotion against cancer of cervix. Nurses with less than nine years of work experience, salary scale U3-U4, without a job description and nurses who followed-up cancer patients were more likely to be involved in health promotional activities against cancer of cervix than those who were not. Recommendation: It is recommended that the Ministry of Health strengthens the cervical cancer prevention programs while providing logistic and in-service training to the health workers so as to increase accessibility and utilisation of cervical cancer prevention services by the clients. Jinja District uses various approaches and media to disseminate health promotional messages against cervical cancer as the hospital conducts three continuous medical sessions on cervical cancer per quarter and gives support for follow up visits. The Ministry of Health and nursing council needs to strengthen its supervisory role to change the nurses’ attitudes towards preventive services.
A Cross Sectional Study of the Knowledge, Attitudes and Practices Regarding Utilization of Modern Contraception Among Women and Men of Namuwongo.
(International Health Sciences University, 2011-09) Nakaggwa, Florence
The United Nations Population Fund (UNFPA) estimates that the world´s population will be 8 billion in 2050. This increase is attributed to the high population growth rate which is influenced by the world´s total fertility rate and contraceptive prevalence rate (CPR). UNFPA has embarked on a drive to increase CPR particularly in developing nations with a focus on modern contraceptive methods, with the hope that this will contribute to a reduction in the overall world population. Uganda´s theme for this year was ¨Uganda at 33 million; Time to Act¨. With an annual population growth rate of 3.3% and a total fertility rate of 6.1, the country needs to increase efforts towards use of modern contraception. This is because there is a high population of unproductive youth in the reproductive age group who are migrating into urban slums where health services and living conditions are inadequate. The purpose of this study was to identify the knowledge, attitude and practices regarding the use of modern contraception among the men and women of Namuwongo slum. Methodology: A cross-sectional study of 282 respondents between the age 15-49 (for the women) participated in the study. Residents who were mentally challenged, and female residents who did not lie in the age range were excluded. Standardized pre-coded and structured questionnaires were used to obtain information from the respondents. The independent variable was use of modern contraception while the dependent variables were knowledge, attitude and practices regarding modern contraceptive use. Results: 193 were females, while 89 were male. 51.1% were youth in the age range 15-24 years. 40.8% of the respondents were unemployed and 63.8% were married. 39.7% of respondents admitted to using contraception. 11.9% of those who said that they were not using contraception, however, they admitted to using condoms which implied that they did not recognize condom use as a method of contraception. This raises the CPR to 46.8%. Nonetheless, 13.5% were contemplating discontinuing use of modern FP because of side effects. The commonest methods were condoms and injections. Knowledge of methods was 78.7%. At p<0.05, knowledge, spousal communication, and final decision making was statistically significant. 60.3% of respondents were not using a modern method of contraception. Side effects constituted 52.1% of perceived obstacles to use of modern contraception. Conclusion: Knowledge of contraception was relatively high, however, CPR is low for a community that has such a high population of youth that are unemployed. The major hindrance which is side effects needs to be addressed to dispel myths surrounding modern FP use. The role of men in influencing modern FP use is important because they are the ones with limited knowledge on FP yet they take part in decision making about the matter.
Determinants of Place of Delivery Among Mothers in Kigungu, Entebbe Health Sub District Wakiso District
(International Health Sciences University, 2011-09) Wavamunno, Priscilla
The study was carried out in order to identify determinants of place of delivery among mothers in Kigungub Entebbe health sub district in Wakiso district. The general objective of the study was the place of delivery of rural mothers. The specific objectives were to determine social demographic factors, maternal factors, cultural factors and health related factors that influence place of delivery among rural mothers in Wakiso district. The study was carried out in Kigungu community, Entebbe health sub district Wakiso district. This is mainly a rural area and it was assumed that mothers here do not deliver in health units for unknown reasons. The district has 7 health sub districts of which only one health sub district was chosen using the simple random method (fish bowl method) as the study area. It was a cross sectional study involving 374 mothers who had delivered a baby in the last 2 years preceding the study and were found living in Kigungu regardless of their duration of stay in the area. The mothers were identified using the snowball method of sampling. Data was collected using an interviewer administered questionnaire to the mothers by the researcher together with the help of research assistants. Data was then coded, cleaned and entered into the computer using EPI-DATA version 3.1 and analysis done using EXCEL 2003/7 and SPSS version 18. Data was presented using frequency distribution, and cross tabulations and statistical tests such as chi square run. The study revealed that the mothers in Wakiso district, the majority of them were 30 years and below (75.4%), married 69.3%, Catholics 35.3%, 42.8% had primary as their highest level of education and 46.8% had either 1 or 2 children. Eighty nine percent of the mothers reported to have delivered in health units while 84% of them went for ante natal care services. Among the determinants of place of delivery in Kigungu village were social demographic factors like parity and religion with p value of 0.001 < the level of sighficance 0.05. Mother’s culture and health workers’ competence were signficant in determing place of delivery with p value of 0.001 < the level of signficance 0.05. Age did not have any significant influence on the place of delivery.
Factors Influencing the Uptake of Mental Health Services to Genocide Victims :
(International Health Sciences University, 2011-09) Buntu, Enock
This study was done to determine the factors that influence the uptake of mental health services to genocide victims, with a case study of Gasabo district, Kigali city, Rwanda. The main objective of the study was to investigate the factors influencing the uptake of mental health services to genocide victims in Rwanda. The specific objectives of the study were to explore client factors that influence the delivery of mental health services, to examine the institutional factors that influence the uptake of mental health services to genocide victims, to investigate the geographical factors that influence the uptake of mental health services to genocide victims and to determine the social, cultural and economic factors that influence the uptake of mental health services to genocide victims. Despite the fact that many studies on post conflict issues, for instance the onset of post-traumatic stress disorder post conflict, very few studies have been carried out in sub Saharan Africa. This means a big knowledge gap still exists in many of these countries, necessitating this study. The study was a cross sectional descriptive study, employing quantitative data collecting methods using two instruments. A self-administered questionnaire was designed and distributed randomly to 300 survivors of genocide with a consent form. On the other hand, a self-administered questionnaire was also randomly distributed to 85 health workers. Of the 300 and 85 copies distributed respectively, all of them were retrieved with hundred percent response rates. SPSS version 15 was used to analyze the data, and Pearson ® correlation coefficient was used to test the significance of the relationships between the variables. The results of the study indicated that most of the respondents were knowledgeable, as regards treatment of mental illness (62.3%), availability of mental health services (83.3%), and the efficacy of the treatment 79%. More so it found out that stigma still exists in Rwanda, for instance 71% of the respondents reported that mental illness is not considered as other illnesses, which is indicative of stigma, explaining why many of the known mentally ill patients in the community do not access care. Furthermore it indicated that many people see government health facilities as being more convenient (55.3%), the challenge is that many reported having to wait for long hours to be attended to (72%). It also found out that there is some health education provided to the community. The study also found that many of the respondents (73.7%) could provide their daily living needs but few of them were able to spare the resources for their health care needs (36.7%). On the side of service delivery it was found that health facilities are not adequately equipped to handle all the psychiatric problems; interestingly 64.7% of the respondents reported that mental health services were offered in Gasabo district. The same was also reported by health workers 82.4%, but the challenge is that a big number of health workers were dissatisfied with salaries. The study recommends that the government of Rwanda and her partner organizations should increase funding to the health sector in general and the mental health care in particular; this is because nearly all issues in service uptake, for instance training of health workers, staffing, remuneration of health workers, health education, equipment of health facilities, to mention but a few revolve around funding. I recommend that studies such as this, be carried out in rural districts of Rwanda to see whether the results can be replicated.
Assess the Capacity of Health Centre IVs to Manage Mental Health Problems :
(International Health Sciences University, 2011-09) Vincent, Mujune
According to the Mental Health Gap Action Programme (MHGAP), mental disorders account for 14% of the global burden of disease; 75% of which are in Low Developed Countries (WHO, 2008). In Uganda, common mental disorders can be detected in 20% to 30% of all outpatient visits common in community health centres (Kigozi et al, 2005). Although it is recommended that majority of cases of mental health problems identified within community be recognized and treated within Community Health Centres, research by Holdaway (2003) shows that up to 50% of patients who present mental health problems fail to have their symptoms recognized by a general medical practitioner. The implications of this are many and present themselves in terms of human social cost and economic cost. The study assessed the capacity of Health Centres IVs to manage mental health problems as a basis for improved mental health service delivery within community Health centres in Uganda. The study uses a case study of Health Centre IVs in Wakiso district as a generalizeable study area representing urban, semi-urban and rural characteristics. The focus of this study is primarily on the capacity of Health Centre IVs, based on their jurisdiction as the main point of referral in each health sub district, to manage mental health problems. The objectives of the study were to identify existing forms of care available for mental health problems, to analyse the capacity of primary health care workers to effectively manage cases of mental health problems and to describe existing mechanisms for resourcing the treatment of mental health problems by 2011. A cross sectional study design was chosen as applied to the case study of Wakiso district. A total of 33 respondents were interviewed. The District Health Officer, Mental Health Focal Person, Psychiatric Clinical officers and Nurses were taken as purposive samples. The health care workers were drawn from Health Centres IVs including Buwambo, Kasangati, Namayumba, Ndejje and Wakiso. Findings show that clinical treatment of mental health problems was the primary form of care provided by 70% of the Health Care Workers followed by psychological care provided by 80.65% of which 75% use counseling as for delivering psychological services to patients. There was limited understanding of techniques such as Cognitive Behaviour Therapy (14.29%), Narrative Exposure Therapy (14.81%), Motivational Interviewing (18.52%) and Group Therapy Sessions (14.81%) which are important for the effectiveness of any counseling interventions. In spite the government effort to recruit Psychiatric Clinical Officers and Nurses on the staff teams at the five Health Centres, the findings show a high propensity for mental health referrals by approximately 89% of health care workers which contests the capacity of the health care workers to manage mental health problems. In addition, of the cases referred, 27.59% of them are made to the resident mental health specialist at each Health Centre IV which denoted limited involvement of general health care workers in treatment on mental health problems. The main source for resourcing mental health care is facilitated by the Government of Uganda with undocumented proportions of out of pocket expenditure by patients and care givers. Although it is evident that resources such psychotropic medicines are well stocked represented by 85% of all health care workers, constraints at the health centres are responsible for limited admissions, follow up and provision of psycho-education services to clients. In conclusion, although efforts have been made to improve the capacity of Health Centre IVs to manage mental health problems, it is important to integrate such efforts with quality control mechanism which can be done through establishment and implementation of effective monitoring and evaluation mechanisms.
Factors Affecting Access and Utilisation of PMTCT Services Among Antenatal Mothers in Referral Health Units in Mbale District
(International Health Sciences University, 2011-09) Kakayi, Jennifer Wandawa
PMTCT was defined as prevention of mother-to-child transmission of HIV a program meant to prevent MTCT of HIV from HIV infected antenatal mothers to their unborn babies and infants either during pregnancy, labour and delivery and breastfeeding. Globally, MTCT accounts for ’over 90 percent of HIV infected children aged under 15 years and of all antenatal mothers attending ANC where HIV positive pregnant mothers are found, at least more than 40 percent infect their infants through MTCT’. An estimated 60 percent of antenatal mothers in Mbale district who had access to PMTCT service only 20 percent utilized the services. This was consistent with the findings of this study where of the 199 (56.1%) antenatal mothers who had access to PMTCT services only 66 (18.4%) utilized the service. Client’s individual factors, health care system, Policy and legal factors were pointed out as the most responsible factors for low uptake of PMTCT services in Mbale district. This was a cross-sectional study design employing qualitative and descriptive methods of data collection. This study targeted sample size was 382 participants and a total of 382 respondents took part in this study representing 100 percent. A total of 355 antenatal mothers irrespective of their HIV sero status and 27 key informants were simple randomly selected from the three referral health units in the district. The findings from this study showed the major factors affecting access and utilization of PMTCT services by antenatal mothers were; low level of education and limited information on PMTCT services accounted for 53.1 percent of the respondents, high costs involved was 80 percent where antenatal mothers paid between 500 to over 4000 UGX for transport to access and utilize PMTCT services. At least 68.8 percent moved a long distance of over 3-5 Kilometers to the referral health units. Long waiting time accounted for over 18 percent who waited beyond 4 hours. Limited space affected privacy and confidentiality contributing to poor access and utilization of services by antenatal mothers. A total of 45 percent feared HCWs knowing their sero status and stigma from the family members and HCWs affected early access and utilization xii of PMTCT services, including adherence problems to ARVs for PMTCT and exposed infant nutrition. There is need for the district health office to initiate integrated outreach for PMTCT services to reach antenatal mothers, equip all Health workers at HFs with the necessary knowledge and skills they need to provide PMTCT services, Motivation in kind and monetory terms would influence change of HCW’s behaviours, their attitudes, practices and unethical behaviors to avoid scaring antenatal mothers from accessing and utilizing PMTCT services at the HFs whenever they went for PMTCT services. Dissemination of PMTCT policy guidelines and legal rights be availed to all HFs for use by stakeholders in order to provide quality aervices and respect the legal rights of the beneficiaries. Strategies to involve men in PMTCT service provision was pertinent. Emphasis on basic education and adequate information by gender would strengthen women’s abilities to bargain for their Reproductive Health Rights through universal access and utilization of PMTC services by antenatal mothers.
Factors Associated with HIV Infection Among Married People Attending Aids Information Centre Clinics in Kampala, Kalangala, Mukono and Wakiso Districts
(International Health Sciences University, 2011-09) Tumusiime, Justine Komunyena;
Introduction; HIV/AIDS is still an over whelming health burden worldwide and worse so in Sub-Saharan Africa. Globally, 33.4 million people were estimated to be living with HIV and 22.4 million were in Sub-Saharan Africa (UNAIDS, 2008). Although UNAIDS 2009, reported reduction of HIV infection world wide by 17% over a period of eight years, reduction in HIV related mortality and morbidity as a result of wide spread use and access to Antiretroviral treatment and the improved HIV health care, UNAIDS, 2010 reported an increase in the people living with HIV/AIDS especially in the Sub-Saharan region to 22.5 million people due to new infections. In absence of a cure, prevention remains a key public health priority especially in the Sub-Saharan Africa. Addressing HIV infection among married couples is critical to the attainment of Millennium development goal six ( Fabian.S.A. et al, 2010). Although, there is still scanty information to whether the HIV infection seen among married couples today was acquired during marriage or it’s a pre existing infection given the fact that, in 1998, 1.9 million Ugandans aged between 12-49 years, majority single were living with HIV/AIDS (UNAIDS 1999). And now the trend has shifted to older age group (30-40years) and majority are married couples (Wabwire et al. 2008). Could the HIV infection among married couples be attributed to the fact that previously HIV infected young people are now grown up and getting married to either negative or positive spouse? This study will retrospectively examine HIV preventive- behavior, socio demographic factors and proximate risk factors among HIV positive married couples (cases) and HIV negative married couples (controls) and comparison will be made. This unmatched case control study was set to identify factors associated with HIV infections among married People attending HIV Voluntary Counseling and Testing and post test club services at AIDS Information Center outreach clinics in Kampala, Mukono, Kalangala and Wakiso districts. Methods: A case–control study conducted with a sample size of 154 married clients. Cases consisted of 78 HIV positive married clients and controls were 76 HIV negative married clients. A Structured interviewer-administered questionnaire was used to collect data on socio-demographic factors, HIV preventive-behavioral factors and proximate risk factors. Statistical analysis was performed using Stata 11.0 and logistic regression. All statistical tests and their respective confidence intervals were based on two-tailed test and were performed at the 5% error rate. Results: The risk of acquiring HIV increased with the increase in the age of the partner, with those who reported to have partners aged forty years and above being four times more likely to have HIV than their counterparts who reported to have younger partners (AOR: 3.91, 95%CI: 0.23- 67.45) Respondents having HIV positive partners or not knowing sero-status of the partner were more likely to be infected with HIV than those who reported to have HIV negative partners (AOR: 12.10, 95% CI: 2.45- 59.84 and AOR: 22.95, 95% CI: 5.08-103.74 respectively). Respondents who reported ever been involved in any bleeding road traffic accidents with other people were thirty-four times more likely to be infected with HIV as compared to their counter parts who did not encounter any bleeding road traffic accidents (AOR: 34.86, 95% CI: 3.08, 394.65) Conclusion: Spouses with older sexual partners (40 years and above) and with high monthly income are at a higher risk of HIV infection than those with young partners and of low monthly income. Having HIV negative results before marriage brings complacency among married couples to test again together and yet ignorance of the current HIV status of the sexual partner is a risk factor for HIV infection. Being involved in any bleeding road traffic accidents and traditional circumcision are risk factors for HIV infection among married people. Recommendations; Interventions to change sexual behavioral patterns are clearly the major priority. More than one HIV tests should be done before people could get married. Routine HIV couple counseling and testing should be mandatory for all married couples to facilitate disclosure of HIV status and emphasize preventive measures among married couples. Increased efforts to totally eliminate traditional circumcision of men and women and work on measures to reduce road traffic accidents as these increase the risk of HIV infection among married couples.
Assessment of the Appropriateness of the Cessation of Breast Feeding Before Two Years by HIV-Positive Mothers.
(International Health Sciences University, 2011-09) Babughirana, Geoffrey
This study was to establish whether HIV positive mothers with weaned children below 2 years meet the AFASS criteria at the PMTCT clinic. The Main Objective of the study was to assess the AFASS criteria for HIV positive mothers with children below 2 years who stopped breastfeeding. And the specific objectives were to assess the acceptability and Feasibility of the feeding practice for the mother, to assess the affordability and sustainability of the feeding practices by the mother and lastly to assess the safety of the feeding practice and the Nutrition status of the child in relation to the feeding practices. Methodology: The research was a cross sectional survey on 378 PMTCT mothers and their infants aged 6-24 months receiving care from Kirudu, Kiswa, Komamboga, Kitebe, and Kisugu health centres of Kampala City. The sample size was determined using Kish’s formula. Data collection techniques and Instruments used were the observation checklist. Questionnaire guide with open ended questions and a MUACtape, data was then entered in the computer using Epi Info, analysis done using the SPSS and Excel. Each of the Criterions was given scores to come up with the desired results Results from the study showed that of the 378 clients 67.9% opted for animal milk, 15.6% complementary feeds, 9.8% for infant formula and 6.6% a non-milk diet. From these respondents 53.9% were found to have made an acceptable choice, 49.8% have practiced a feasible option and 12.9% could actually afford the choice they made, 28.8% were practicing a safe option and 56.1% could sustain their choice. With such results the study therefore led to a conclusion that counselling mothers on infant feeding options basing on the AFASS criteria is not realistic and the health system should consider other practical interventions such as exploring practices like heat treatment of expressed breastmilk, investing in community based monitoring of these clients and localized recommendation for AFASS
Assessment of the Road Safeness and Prevalence of Road Traffic Accidents in Uganda:
(International Health Sciences University, 2011-09) Nankya, Prossy Lwanga
The study was carried out to assess road safeness and prevalence of road traffic accidents in Uganda; it was a cross-sectional survey with both qualitative and quantitative data collected. Findings indicated that road traffic accidents affect pedestrians more than any other road user, the major human cause of accidents was careless driving and most accidents occurred in the evening between 4pm and 8pm, morning between 7am and 8am and lunch time between 12 noon and 2pm. All roads were congested with many pot holes, had no pedestrian walkways and few safety features. Most vehicles lacked certain parts critical for safety. Corruption was the major factor affecting implementation of road policies. The study recommends educational campaigns through schools, review of vehicle inspection system and safety controls, adequate traffic signage, safety features including pedestrian walkways, adequate training to traffic police officers and provision of adequate resources. Background: Everyday approximately 3,000 people die and 30,000 people are seriously injured on the world’s roads (WHO 2004). Globally, trauma resulting from road traffic crashes is a major cause of death and disability with the majority occurring in developing countries (Nantulya et al 2002). According to Injury Control Centre Uganda Executive Director (2009) 44% of all injuries presented in hospitals are due to road traffic crashes. In Uganda, road traffic crashes have increased by 90% since 2000 and in 2007 almost 10,000 people were injured and over 2,000 died from road traffic accidents; this puts a significant strain on the already stretched health facilities and poor families who may experience the loss of income from a bread winner in addition to the burden of caring for those injured. Objectives: Major objective; To assess the road safeness and accident prevalence in central region. Specific objectives: To establish the prevalence of road traffic accidents in Kampala area. To determine the human factors influencing road safety in Kampala area. To determine the condition and terrain of the roads in Kampala area. To determine the vehicle conditions affecting road safety in Kampala area. To determine the factors influencing implementation of road policies Kampala area. Methodology: the study was a cross-sectional survey with both qualitative and quantitative data collected. 192 respondents were interviewed, of which 48 were drivers, 48 were passengers, 48 were riders and 48 were pedestrians. Observation was done on all the 20 roads in the study for a period of one hour. 40 vehicles were examined, every fifth vehicle parked on the different roads was chosen. Results Source: Primary data. The figure shows that 36.4% of drivers wore seat-belts while 63.6% did not wear seat-belts. 25% of riders wore helmets while 75% did not wear helmets. 70% of drivers and riders were distracted with 65% talking to passenger, 31.6% talking on phone, 25% reading newspapers and 5% were texting on phone. Figure 2 shows that pedestrians are affected most in road traffic accidents with 49.47% killed, 41.57% seriously injured and 36.82% slightly injured. The figure shows that most accidents occur in the evening, between 4pm and 8pm; in the morning hours between 7am and 9am; and lunch time between 12 noon and 2pm. Implementation of road policies is mainly influenced by corruption, limited resources, driver ignorance and personnel shortage as shown in the figure below. Discussion Findings indicated that pedestrians were more affected in road traffic accident which is in contrast to the results from analysis of factors affecting road safety: the Greek experience (Golias. J. C.et al, 1997) where more drivers were affected followed by passengers and pedestrians. Human factors accounted for 95.26% of road traffic accidents which is consistent with results of the comprehensive study of road safety (Treat et al, 1977) where human factors accounted for 57%. The hourly variation of 4pm to 8pm is consistent with the Greek experience (Golias, J. C.et al, 1997) where a significant number of fatal accidents occurred during evening hours (6pm to midnight). This can be attributed to rush hour movement as people travel back home with most of them tired from the day’s work. The roads had no pedestrian walkways, with many pot holes and poor drainage which leads to wear and tear of roads. The road condition is also affected by overloading which deteriorates the road net work and reduces road life span (Watkins et al, 2009). Conclusion: Pedestrians were the most affected road users in Uganda during 2010. Human factors cause more road traffic accidents than vehicle, road factors. Ugandan roads were in a poor state and yet too congested. Vehicles lacked certain parts critical for safety. Corruption was the major factor influencing implementation of road policies. Recommendations: There should be educational campaigns on traffic safety, review of the vehicle inspection system, improved road condition through adequate traffic signage and safety features including construction of pedestrian walkways and provision of adequate resources for traffic police department.
Factors Influencing the Performance of Village Health Teams (VHTS) in Health Promotion :
(Internationl Health Sciences University, 2011-09) Nakigudde, Faith
The study focused on examining the various factors that directly and indirectly influence the performance of VHT activities. The study was based on a scientific fact that incentives, availability of supplies and support supervisions have significant impact on the quality of health services offered by VHTs. Substantively the study has revealed positive results, that incentives influence the performance of VHTs in terms of motivation and retention. Secondly the study has shown that lack of sufficient supplies has negatively affected the performance of service delivery in terms of availability and accessibility. Thirdly, the study has revealed there is a dire need to adopt an effective supervisory mechanism for technical development and for the sustainability of VHT activities in the area. The study was conducted in Makindye division in Central Uganda In order to capture comprehensive results, the researcher adopted a cross sectional descriptive methods; the researcher employed a questionnaire with both open ended and closed ended questionnaires to gather data. Also, the researcher acquired an interview guide to gather qualitative data. In need to test for the relationship between the independent variables that is incentives, supplies and support supervision, the researcher ran chi square test and established that there was a significant relationship between variables that is the presence of incentives, supplies and support supervision on VHTs performance and in their absence, it leads to high attrition rate and poor health outcome. In conclusion, the researcher argued that for quality service delivery by VHTs in health promotion, there is a great need to improve on the availability of incentives, supplies and support supervision; it is only by sincere involvement of community members that health quality in the area can be realized. Therefore, the researcher recommended for horizontal form of management to ensure continuity and sustainability of VHT activities.

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