Appropriate management of malaria demands early health seeking behaviour upon suspicion of malaria-like symptoms. This study examined malaria treatment seeking behaviour and associated factors among ...international students at University of Ghana. The study used a cross-sectional and quantitative approach. Data collection was undertaken using a structured questionnaire administered on a random sample of 264 international students. Data obtained on malaria treatment and factors influencing treatment behaviors were analyzed using IBM, SPSS Statistics version 22. Associations between individual characteristics and Malaria treatment seeking behavior was assessed by Pearson Chi-square(X.sup.2) test of independence. Binary logistic regression model was built using a backwards Wald approach, with variables retained at Wald p-value <0.05. The findings show that 35% of the respondents obtained self-prescribed antimalarial at their utmost first choice of Malaria treatment. At bivariate level, a significant relationship between Malaria health-care seeking behaviour and:- Respondents continent, X.sup.2 (1, N = 264) = 7.936, p = .005; Service accessibility, X.sup.2 (1, N = 264) = 7.624, p = .006; Wait time, X.sup.2 (1, N = 264) = 22.514, p <0.001; Treatment cost, X.sup.2 (1, N = 264) = 97.160, p <0.001; Health insurance, X.sup.2 (1, N = 264) = 5.837, p = 0.016, and Perceived staff attitude, X.sup.2 (1, N = 264) = 18.557, p < 0.001. At multivariable analysis, inappropriate malaria health seeking behaviours was associated with low perceived service accessibility as (greater than or equal to30mins) (aOR = 6.67; p<0.001), perceived long wait time (greater than or equal to30mins), (aOR = 5.94; p = 0.015), perceived treatment cost affordability (<15 GHC) (aOR = 19.88; p<0.001) and age group: -34-41years (aOR = 8.83; p<0.001). There were widespread inappropriate health-care seeking behavior for Malaria treatment among international students. Improving accessibility to malaria treatment services, reducing wait time at health facilities and the treatment cost will address inappropriate malaria treatment health seeking behaviours among the international students.
Considering the COVID-19 global public health crisis, this paper examines the socio-cultural, economic and psychosocial impact of the pandemic on urban refugees in Uganda. We analyse the living ...conditions of urban refugees that make it problematic for them to adhere to public health measures. Since COVID-19 is perceived as “imported”, refugees are assumed as its potential transmitters, consequently experiencing heightened stigma and isolation. Lack of culturally and linguistically accessible information and services excludes them from on-going efforts to prevent the pandemic. The lockdown has affected refugee livelihoods and increased income insecurity, sexual and gender-based violence and anxiety. Given the paucity of government-led services to contain the epidemic, we argue that contingency planning must involve refugees and their communities to access accurate and relevant information in appropriate languages. It is also important to build the capacity of frontline workers to understand the specific needs of refugees to deliver appropriate protection in the context of the pandemic.
PurposeThe study drew on capacity framework around the individual, organisational, health system and wider context to explore gaps in health supply chain (HSC) workers capacity and competency to ...perform supply chain (SC) functions and the lessons for workforce development.Design/methodology/approachA mixed-method study was conducted across the Northern Region of Ghana. Qualitative data were collected from in-depth interviews with 34 key SC managers at the regional, district and facility levels. A semi-structured questionnaire was administered through the RedCap mobile app to 233 core HSC workers and non-core workers (clinicians with additional responsibilities in SC). Data were managed and analysed inductively and deductively for themes.FindingsWeak knowledge and competency in SC functions attributed to poor training exposure and organisational support for capacity building, undermined the capacity to perform basic SC functions, especially by the non-core category. The policy and regulatory environment of the HSC marketplace were described as fluid and with complexity of demands. Both worker categories, therefore, requested functional, technical, managerial and customer care competencies to anticipate and manage complexities. Structural characteristics of the health system giving narrow decision space to HSC workers cascaded the capacity for innovation and initiative and promoted frustrations among mid-level managers. Infrastructural deficits and shortfalls in operational resources scaled back the capacity to efficiently manage inventory and ensure that commodities reach clients in good quality.Originality/valueFinding suggest that capacity building of HSC workers, strengthening of health institutions structural and resource capacity, and leveraging on technology will enable optimal performance of HSC functions.
Background HIV/AIDS continues to be a significant contributor to illness and death, particularly in sub-Saharan Africa. In this study, we conducted a qualitative assessment to understand Client and ...Healthcare Provider Perspectives on Differential Service Delivery Models in Uganda. The purpose was to establish strengths and weaknesses within the services delivery models, inform policy and decision-making, and to facilitate context specific solutions. Methods Between February and April 2023, a qualitative cross-sectional study was utilised to gather insights from a targeted selection of individuals, including People Living with HIV (PLHIV), healthcare workers, HIV focal persons, community retail pharmacists, and various stakeholders. The data collection process included eleven in-depth interviews, nine key informant interviews, and eight focus group discussions carried out across eight districts in Central Uganda. The collected data was analyzed through inductive thematic analysis with the aid of Excel. Results The various Differentiated Service Delivery Models (DSDMs), notably Community-Client-Led Drug Distribution (CCLAD), Community Drug Distribution Point (CDDP), Community Retail Pharmacy Drug Distribution Point (CRPDDP), and the facility-based Facility Based Individual Model (FBIM), were reported to have several positive impacts. These included improved treatment adherence, efficient management of antiretroviral (ARV) supplies, reduced exposure to infectious diseases, enhanced healthcare worker hospitality, minimized travel time for ART refills, stigma reduction, and decreased waiting times. Concern was raised about the lack of improvement in HIV status disclosure, opportunistic infection treatment, adherence to seasonal appointments, and sustainability due to the overreliance of the DSDMs on donor funding, suggesting potential discontinuation without funding. Doubts about health workers' commitment surfaced. Notably, the CCLAD model displayed self-sustainability, with clients financially supporting group members to collect medicines. Conclusion Community-based DSDMs, such as CCLAD and CDDP, improve ART refill convenience, social support, and client experiences. These models reduce travel and waiting times, lowering infection risks. Addressing challenges and enhancing facility-based models is vital. In order to maintain funding after donor funding ends, sustainability measures like cross-subsidization can be used. If well implemented, the DSDMs have the potential to produce better or comparable ART outcomes compared to the FBIM model.
Although microscopy remains the gold standard for malaria diagnosis, little is known about its accuracy in the private health facilities in Uganda. This study evaluated the accuracy of malaria ...microscopy, and factors associated with inaccurate smear results at private health facilities in Entebbe Municipality, Uganda.
Between April and May 2018, all patients referred for a malaria smear in 16 private health facilities in Entebbe municipality were screened, and 321 patients were enrolled. A questionnaire was administered to collect demographic and clinical information, facility-based smear results were recorded from the participant's consultation notes, and a research slide was obtained for expert microscopy during exit interview. A health facility assessment was conducted, and information on experience in performing malaria microscopy was collected from all facility personnel reading smears and the data was linked to the participant's clinic visit.
The test positivity rate of malaria parasitaemia was 15.0% by expert microscopy. The sensitivity, specificity and negative predictive value of the facility-based microscopy were high (95.8%, 90.1 and 99.2%, respectively). However; the positive predictive value (PPV) was low with 27/73 (63%) patients diagnosed with malaria not having the disease. Majority of the inaccurate results were from 2 of the 23 laboratory personnel reading the smears. The factors associated with inaccurate smear readings included being read by a technician; (1) who had less than 5 years' experience in reading malaria smears (adjusted Odds Ratio aOR = 9.74, 95% confidence interval CI (1.06-89.5), p-value = 0.04), and (2) who was examining less than 5 smears a day (aOR = 38.8, 95% CI 9.65-156, p-value < 0.001).
The accuracy of malaria microscopy in this setting was high, although one third of the patients diagnosed with malaria did not have the disease. Majority of the errors in smear readings were made by two laboratory personnel, with the main factor associated with inaccurate smear results being low experience in malaria microscopy. In-service training may be sufficient to eliminate inaccurate smear results in this setting, and these private facilities would be ideal model facilities to improve the quality of malaria microscopy in Uganda especially in the public sector where accuracy is still poor.
IntroductionAppropriate management of malaria demands early health seeking behaviour upon suspicion of malaria-like symptoms. This study examined malaria treatment seeking behaviour and associated ...factors among international students at University of Ghana.MethodsThe study used a cross-sectional and quantitative approach. Data collection was undertaken using a structured questionnaire administered on a random sample of 264 international students. Data obtained on malaria treatment and factors influencing treatment behaviors were analyzed using IBM, SPSS Statistics version 22. Associations between individual characteristics and Malaria treatment seeking behavior was assessed by Pearson Chi-square(X2) test of independence. Binary logistic regression model was built using a backwards Wald approach, with variables retained at Wald p-value <0.05.ResultsThe findings show that 35% of the respondents obtained self-prescribed antimalarial at their utmost first choice of Malaria treatment. At bivariate level, a significant relationship between Malaria health-care seeking behaviour and:- Respondents continent, X2(1, N = 264) = 7.936, p = .005; Service accessibility, X2(1, N = 264) = 7.624, p = .006; Wait time, X2(1, N = 264) = 22.514, p <0.001; Treatment cost, X2(1, N = 264) = 97.160, p <0.001; Health insurance, X2(1, N = 264) = 5.837, p = 0.016, and Perceived staff attitude, X2(1, N = 264) = 18.557, p < 0.001. At multivariable analysis, inappropriate malaria health seeking behaviours was associated with low perceived service accessibility as (≥30mins) (aOR = 6.67; p<0.001), perceived long wait time (≥30mins), (aOR = 5.94; p = 0.015), perceived treatment cost affordability (<15 GHC) (aOR = 19.88; p<0.001) and age group: -34-41years (aOR = 8.83; p<0.001).ConclusionThere were widespread inappropriate health-care seeking behavior for Malaria treatment among international students. Improving accessibility to malaria treatment services, reducing wait time at health facilities and the treatment cost will address inappropriate malaria treatment health seeking behaviours among the international students.
Purpose: This study sought to determine the magnitude of patients' misdiagnosis, classify the extent to which patients were misdiagnosed, determine the major diagnostic groupings and the topmost ...misdiagnosed diseases 11th version of the International Classification of Diseases (ICD-11). Methods: We conducted a retrospective review of 2431 patients' records. A patient was adjudged to have been misdiagnosed if there was a difference between the initial diagnosis and the final diagnoses which had been collectively and collaboratively agreed upon review on admission. Misdiagnosis was classified as Class I, Class II, Class III and Class IV. The Pareto analysis was used to determine the topmost misdiagnosed diseases and ICD-11 major diagnostic groupings. We established the three leading misdiagnosed diseases for each of the topmost ICD-11 major diagnostic groupings. Results: The results indicate that 9.2% (223/2341) of the inpatients were initially misdiagnosed. There were 303 conditions involved in the misdiagnosis. The majority, 70.9% (158/223) of the misdiagnosed patients were classified as Class I. The ICD-11 major diagnostic groupings accounted for at least 80% of the misdiagnosis were certain infectious or parasitic diseases (32%), diseases of the digestive system (12%), diseases of the circulatory system (11%), endocrine, nutritional or metabolic disorders (9%), diseases of the respiratory system (7%), diseases of the genitourinary system 20/303 (7%), and diseases of blood and blood forming organs (5%). The 19 topmost misdiagnosed diseases or conditions included; peptic ulcer disease, severe malaria, hypertension, gastroenteritis, pneumonia, urinary tract infection, enteric fever, tuberculosis, septicemia, bacteremia, anaemia, congestive cardiac failure, diabetes mellitus, stroke, chronic obstructive pulmonary disease, respiratory tract infection, cystitis, cryptococcal meningitis, epilepsy and gastritis. Conclusion: Efforts to improve patient diagnosis should focus on the "vital few" topmost misdiagnosed conditions and ICD-11 major diagnostic groupings that account for at least 80% of the burden of the misdiagnosis. Keywords: prevalence, classification, misdiagnosis, general hospitals
Evidence is lacking about condom use among out-of-school young people (OS-YP) on anti-retroviral therapy (ART). This study aimed to understand the factors associated with consistent condom use among ...OS-YP aged 15-24 years old on ART in Central Uganda.
This was a quantitative descriptive cross-sectional study conducted among 357 OS-YP on ART from seven districts of Central Uganda. Interviewer-administered questionnaire was used to collect data on consistent condom use in the past 12 months from OS-YP, aged 15-24 years, who did not intend to have children in that period. Consistent condom use by participants was considered to be the routine (always) use of condoms during sexual intercourse in the past 12 months. Frequencies and percentages were used for univariate analysis, while Pearson's Chi-square was used to determine bivariate association and logistic regression analysis for multivariable association with consistent condom use, at 95% confidence level.
Of the 357 sexually active OS-YP on ART, 73% were females. The age range of study participants was between 15 and 24 years old (with a mean ± standard deviation of 20±3 years) where 55% were aged 20 to 24 years, while their sexual partners were aged ≥25 years, and 49% of respondents did not use condoms. Primary school education level, being employed, rural residence, and receiving ART from health facilities with a perceived adequate number of health workers were strongly associated with consistent condom use with the adjusted odds ratio (AOR) of 0.2 (95% CI 0.07-0.69) level of education; 2.12 (95% CI 1.06-4.26) employment status; 2.46 (95% CI 1.19-5.10) residence and 6.08 (95% CI 1.05-35.22) perceived level of staffing at the health facility, respectively.
Efforts to increase consistent condom use should focus on recruiting more providers in health facilities to intensify condom use sensitization among sexually active young people on ART in the context of HIV epidemic control.
Introduction: It is crucial to have satisfactory coverage of safe motherhood services in order to prevent birth defects and child disabilities. Mildmay Uganda Institute of Health Sciences (MIHS) ...implemented a safe motherhood project aimed at preventing birth defects and child disabilities. Methods: Three years after the project’s implementation, a rapid cross-sectional health facility survey was conducted in 4 districts of central Uganda to assess the coverage of key safe motherhood and early childhood services. The Lot Quality Assurance Sampling approach was used to assess coverage of 16 indicators in the areas of ANC, skilled birth attendance, early childhood care, postnatal care, and knowledge about child disability prevention. A Decision Rule was set at 80% upper threshold to classify the performance of health facilities at the district level. Results: The survey found that there was variation in performance across indicators and districts. All districts achieved the 80% coverage target in ANC first visit, mothers who received at least two doses of Fansidar for intermittent preventive treatment of malaria in pregnancy, and mothers with knowledge of the action to take in case they suspect childhood disability. Folic acid supplementation during pregnancy and screening for birth defects using the Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score had overall coverage above the target, but one district each had coverage below target in each of these 2 indicators. The coverage target was not reached in the rest of the survey indicators in each of the districts. Conclusion: Well-performing districts, especially in indicators with inconsistent performance, offer valuable insights for learning and adapting interventions in districts that do not meet the desired coverage of those particular indicators. Considering the disparities in performance among different indicators and districts, project planners should adopt, modify and implement successful strategies in districts and indicators that perform well. By doing so, they can enhance the performance of under performing districts or indicators.
PDF
