BACKGROUND
A safe and adequate supply of blood is critical to improving health care systems in sub‐Saharan Africa, where little is known about the current use of blood. The aim of this study was to ...comprehensively describe the use of blood at a tertiary care hospital to inform future efforts to strengthen blood programs in resource‐limited settings.
STUDY DESIGN AND METHODS
Data were collected from blood bank documentation for all units issued at Mulago Hospital Complex in Kampala, Uganda, from mid‐January to mid‐April 2014.
RESULTS
A total of 6330 units (69% whole blood, 32% red blood cells, 6% platelets, 2% plasma) were issued over the 3‐month study period to 3662 unique patients. Transfusion recipients were 58% female and median age was 27 years (interquartile range IQR, 14–41). Median pretransfusion hemoglobin was 5.6 g/dL (IQR, 4.0–7.2 g/dL, n = 1090). Strikingly, cancer was the top indication for transfusion (33.5%), followed by pregnancy‐related complications (12.4%) and sickle cell disease (6.9%).
CONCLUSION
This study provides a comprehensive picture of blood use at a national referral hospital in sub‐Saharan Africa. Noncommunicable diseases, particularly oncologic conditions, represent a large proportion of demand for transfusion services.
Background
The prevalence of heart failure (HF) is increasing in Uganda. Ugandan patients with HF report receiving limited information about their illness and associated self-care behaviours. ...Interventions targeted at improving HF self-care have been shown to improve patient quality of life and reduce hospitalizations in high-income countries. However, such interventions remain underutilized in resource-limited settings like Uganda. This study aimed to develop a digital health intervention that enables improved self-care amongst HF patients in Uganda.
Methods
We implemented a user-centred design (UCD) process to develop a self-care intervention entitled Medly Uganda. The ideation phase comprised a scoping review and preliminary data collection amongst HF patients and clinicians in Uganda. An iterative design process was then used to advance an initial prototype into a functional digital health intervention. The evaluation phase involved usability testing of the intervention amongst Ugandan patients with HF and their clinicians.
Results
Medly Uganda is a digital health intervention that allows patients to report daily HF symptoms, receive tailored treatment advice and connect with a clinician when showing signs of decompensation. The system harnesses Unstructured Supplementary Service Data (USSD) technology that is already widely used in Uganda for mobile phone-based financial transactions. Usability testing showed Medly Uganda to be both acceptable and feasible amongst clinicians, patients and caregivers.
Conclusions
Medly Uganda is a functional digital health intervention with demonstrated acceptability and feasibility in enabling Ugandan HF patients to better care for themselves. We are hopeful that the system will improve self-care efficacy amongst HF patients in Uganda.
Although several studies have shown short term health benefits of exclusive breastfeeding (EBF), its long term consequences have not been studied extensively in low-income contexts. This study ...assessed the impact of an EBF promotion initiative for 6 months on early childhood caries (ECC) and breastfeeding duration in children aged 5 years in Mbale, Eastern Uganda.
Participants were recruited from the Ugandan site of the PROMISE- EBF cluster randomised trial (ClinicalTrials.gov no: NCT00397150). A total of 765 pregnant women from 24 clusters were included in the ratio 1:1 to receive peer counselled promotion of EBF as the intervention or standard of care. At the 5 year follow-up, ECC was recorded under field conditions using the World Health Organization's decayed missing filled tooth (dmft) index. Adjusted negative binomial and linear regression were used in the analysis.
Mean breastfeeding duration in the intervention and control groups (n=417) were 21.8 (CI 20.7-22.9) and 21.3(CI 20.7-21.9) months, respectively. The mean dmft was 1.5 (standard deviation SD 2.9) and 1.7 (SD 2.9) in the intervention and control groups, respectively. Corresponding prevalence estimates of ECC were 38% and 41%. Negative binomial regression analysis adjusted for cluster effects and loss-to-follow-up by inverse probability weights (IPW) showed an incidence-rate ratio (IRR) of 0.91 (95% CI 0.65-1.2). Comparing the effect of the trial arm on breastfeeding duration showed a difference in months of 0.48 (-0.72 to 1.7).
PROMISE EBF trial did not impact on early childhood caries or breastfeeding duration at 5 years of age. This study contributes to the body of evidence that promotion of exclusive breastfeeding does not raise oral health concerns. However, the high burden of caries calls for efforts to improve the oral health condition in this setting.
ClinicalTrials.gov NCT00397150.
This study was intended to understand how smallholder farmers’ modifications improved agroforestry technologies’ usability in Uganda’s Mt. Elgon region. We used a case study approach to understand ...how smallholder farmers’ contextual realities informed their modifications and enhanced the usability of agroforestry technologies. Data was collected over four months of frequent and regular interaction with the cases using formal and informal methods that included in-depth interviews, conversations, discussions, and direct observations. Emerging themes and patterns were identified from the comprehensively reduced data. In addition, respondents’ direct quotes were used to emphasize the reasons for the modifications. The findings showed that smallholder farmers modified the recommended technologies to suit their biophysical and socio-economic realities. Differences and similarities in modifications existed among cases across the agroforestry technologies. The modifications were mainly done to diversify tree uses, optimize space utilization, and minimize production costs for farming households. These findings imply a need to critically examine the smallholder farmers’ modifications to make agroforestry technologies applicable and compliant to their contexts. This will inform the re-invention of technologies that will quickly diffuse into the community for broader impact. Findings also emphasize the need to rethink the linear model of technology transfer mainly applied in agroforestry technology development and dissemination because it offers limited space for the much-needed feedback from smallholder farmers.
In Sub-Saharan Africa, agroforestry has been identified as the most sustainable remedy to counter declining farm productivity. Over the last decades, researchers and other actors have promoted ...several agroforestry technologies to improve farm productivity. Sometimes, the promotion message provided through extension assumes a homogenous smallholder farmers’ context. However, smallholder farmers’ social and farm contexts are heterogeneous. Smallholder farmers make different choices of which technologies fit their contexts. A range of factor categories influence and (re)shape choice decisions of smallholder farmers. In this paper, the authors seek to articulate the importance of socio-technological factors shaping smallholder farmers’ choices of specific agroforestry technologies on their farms. Knowledge of these factors provides insights that inform the design of refined farmer context-based extension messages, consequently enhancing the scaling-up of agroforestry technologies. The Decomposed Theory of Planned Behaviour was used as the main framework to understand smallholder farmers’ choice decisions among agroforestry technologies. We used a mixed methods approach. Quantitative data were collected from 277 randomly selected farming households in the eastern highlands of Uganda. Qualitative data that complemented the quantitative were collected using focus group discussions. An alternative-specific conditional logit model was used to model smallholder farmers’ agroforestry choices. Results indicated that the number of tree species desired by the farmer and the perceived value of the technology were the most critical factors that commonly influence smallholder farmers’ choice of agroforestry technologies. The influence of other factors such as gender, the number of training sessions attended, total land owned, peer influence and perceived behavioural control were technology-specific, suggesting the need to tailor agroforestry interventions to specific farmer categories.
Health policies in Africa are shifting towards integrated care services for chronic conditions, but in parts of Africa robust evidence on effectiveness is limited. We assessed the integration of ...vertical health services for HIV, diabetes and hypertension provided in a feasibility study within five health facilities in Uganda. From November 2018 to January 2020, we conducted a series of three in-depth interviews with 31, 29 and 24 service users attending the integrated clinics within Kampala and Wakiso districts. Ten healthcare workers were interviewed twice during the same period. Interviews were conducted in Luganda, translated into English, and analysed thematically using the concepts of availability, affordability and acceptability. All participants reported shortages of diabetes and hypertension drugs and diagnostic equipment prior to the establishment of the integrated clinics. These shortages were mostly addressed in the integrated clinics through a drugs buffer. Integration did not affect the already good provision of anti-retroviral therapy. The cost of transport reduced because of fewer clinic visits after integration. Healthcare workers reported that the main cause of non-adherence among users with diabetes and hypertension was poverty. Participants with diabetes and hypertension reported they could not afford private clinical investigations or purchase drugs prior to the establishment of the integrated clinics. The strengthening of drug supply for non-communicable conditions in the integrated clinics was welcomed. Most participants observed that the integrated clinic reduced feelings of stigma for those living with HIV. Sharing the clinic afforded privacy about an individual's condition, and users were comfortable with the waiting room sitting arrangement. We found that integrating non-communicable disease and HIV care had benefits for all users. Integrated care could be an effective model of care if service users have access to a reliable supply of basic medicines for both HIV and non-communicable disease conditions.
Understanding the economic implications of COVID-19 for the HIV epidemic and response is critical for designing policies and strategies to effectively sustain past gains and accelerate progress to ...end these colliding pandemics. While considerable cross-national empirical evidence exists at the global level, there is a paucity of such deep-dive evidence at national level. This article addresses this gap. While Zimbabwe experienced fewer COVID-19 cases and deaths than most countries, the pandemic has had profound economic effects, reducing gross domestic product by nearly 7% in 2020. This exacerbates the long-term economic crisis that began in 1998. This has left many households vulnerable to the economic fallout from COVID-19, with the number of the extreme poor having increased to 49% of the population in 2020 (up from 38% in 2019). The national HIV response, largely financed externally, has been one of the few bright spots. Overall, macro-economic and social conditions heavily affected the capacity of Zimbabwe to respond to COVID-19. Few options were available for borrowing the needed sums of money. National outlays for COVID-19 mitigation and vaccination amounted to 2% of GDP, with one-third funded by external donors. Service delivery innovations helped sustain access to HIV treatment during national lockdowns. As a result of reduced access to HIV testing, the number of people initiating HIV treatment declined. In the short term, there are likely to be few immediate health care consequences of the slowdown in treatment initiation due to the country's already high level of HIV treatment coverage. However, a longer-lasting slowdown could impede national progress towards ending HIV and AIDS. The findings suggest a need to finance the global commons, specifically recognising that investing in health care is investing in economic recovery.
The Framework and Guidelines on Land Policy in Africa endorsed through the adoption of the African Union Declaration on Land Issues and Challenges by the African Heads of States in 2009 is having “a ...strong gender component which aims at “strengthening security of land tenure for women which require special attention” and “ensuring that land laws provide for equitable access to land and related resources”. Despite this progressive framework, restricted rights to access, use, inheritance, control and ownership of land by women in Africa are still strongly felt at grassroots level and can be attributed to the imbalances of power relations between men and women based on patriarchal systems and associated social norms that discriminate against women. Women in Sub-Saharan Africa do not have equal rights to make key decisions on land because they are considered to be mere “guardians”, holding land in trust for their sons (Uvuza, 2016). By strengthening grassroots women collective capacity to effectively engage social, cultural and political systems and practices that obstruct grassroots women equality with men on matters of land, it helps in influencing change for an engendered land governance respecting traditional structures. This paper will focus on the results of a multi countries project which aims at creating a pathway to economic justice on women’s land rights to empower women in Kenya, Uganda, Nigeria and Zimbabwe. The project is targeting grassroots women that are affected by unequal land and property ownership, to be at the forefront of demanding the implementation of the existing progressive policies to achieve equity and equality in property and land ownership. The project brought grassroots women from across Africa within the banner of one common cause, to amplify the voice of African women against the tyranny of injustice with regards to land and property rights. In this sense it is working to bring the marginalized, socially, culturally and economically excluded grassroots women to the mainstream where they can challenge inequalities and champion their own development. Empowered grassroots women developed the confidence and propensity to advocate for their ownership of land with decision makers and duty bearers creating a shift in cultural and social norms at local level. Collaborations between grassroots women and traditional and local leaders forged through the project have inspired the creation of an inclusive environment which supports women to participate in available economic and political spaces. As an example, grassroots women were standing for leadership positions in their localities during national elections in Uganda. They were vying for positions of councilors and women representatives.
Objective
To estimate the effect of distal and proximal early life‐course factors on early childhood caries (ECC) in 5‐year‐old Ugandan children, particularly focusing on the causal effect of ...exclusive breast feeding (EBF) on ECC using directed acyclic graphs (DAGs) for confounder selection.
Methods
This study had a nested prospective cohort design, focusing on 5 years of follow‐ups of caregiver‐children pairs from the PROMISE‐EBF trial (ClinicalTrials.gov no: NCT00397150) conducted in 2011 in Eastern Uganda. Data were from recruitment interviews, 24‐week, 2‐year and 5‐year follow‐ups of a cohort of 417 mother‐children pairs. Trained research assistants performed interviews with caregivers in the local language and ECC was recorded under field conditions using the World Health Organization's (WHO) decayed missing or filled teeth (dmft) index. Early life‐course factors in terms of socio‐demographic characteristics, EBF and other feeding habits were assessed at the various follow‐ups. The outcome (ECC; dmft>0) was assessed at the 5‐year follow‐up. Causal diagrams as DAGs were constructed to guide the selection of confounding and collider variables to be included in or excluded from the final multivariable analysis. Negative binomial regression analyses were performed based on two comparative DAGs representing different causal models.
Results
Model 1 based on DAG 1, showed EBF to be a protective factor against ECC, with an IRR and 95% CI of 0.62 (0.43‐0.91). According to Model 2 based on DAG 2, EBF and having both parents living together had protective effects: the corresponding IRRs and 95% CI were 0.60 (0.41‐0.88) and 0.48 (0.25‐0.90), respectively.
Conclusions
Both plausible models indicated that being exclusively breastfed for 24 weeks had a protective causal effect against ECC. Further research, examining the unmeasured variables included in the DAGs is necessary to strengthen the present finding and allow stronger causal claims.
Health policies in Africa are shifting towards integrated care services for chronic conditions, but in parts of Africa robust evidence on effectiveness is limited. We assessed the integration of ...vertical health services for HIV, diabetes and hypertension provided in a feasibility study within five health facilities in Uganda. From November 2018 to January 2020, we conducted a series of three in-depth interviews with 31, 29 and 24 service users attending the integrated clinics within Kampala and Wakiso districts. Ten healthcare workers were interviewed twice during the same period. Interviews were conducted in Luganda, translated into English, and analysed thematically using the concepts of availability, affordability and acceptability. All participants reported shortages of diabetes and hypertension drugs and diagnostic equipment prior to the establishment of the integrated clinics. These shortages were mostly addressed in the integrated clinics through a drugs buffer. Integration did not affect the already good provision of anti-retroviral therapy. The cost of transport reduced because of fewer clinic visits after integration. Healthcare workers reported that the main cause of non-adherence among users with diabetes and hypertension was poverty. Participants with diabetes and hypertension reported they could not afford private clinical investigations or purchase drugs prior to the establishment of the integrated clinics. The strengthening of drug supply for non-communicable conditions in the integrated clinics was welcomed. Most participants observed that the integrated clinic reduced feelings of stigma for those living with HIV. Sharing the clinic afforded privacy about an individual’s condition, and users were comfortable with the waiting room sitting arrangement. We found that integrating non-communicable disease and HIV care had benefits for all users. Integrated care could be an effective model of care if service users have access to a reliable supply of basic medicines for both HIV and non-communicable disease conditions.
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