'What kind of life is this?' Diabetes related notions of wellbeing among adults in eastern Uganda and implications for mitigating future chronic disease risk.

BACKGROUND: Effective prevention and care for type 2 diabetes requires that people link healthy behaviours to chronic disease-related wellbeing. This study explored how people perceive current and future wellbeing, so as to inform lifestyle education. METHODS: Eight focus group discussions and 12 in-depth interviews were conducted in Iganga and Mayuge districts in rural Eastern Uganda among people aged 35-60 years in three risk categories (1) People with diabetes, (2) people at higher risk of diabetes (with hypertension or overweight) and (3) community members without diabetes. RESULTS: People define wellbeing in three notions: 1) Physical health, 2) Socio-economic status and 3) Aspirational fulfilment. Most people hold the narrower view of wellbeing that focuses on absence of pain. Most overweight participants did not feel their condition as affecting their wellbeing. However, for several people with hypertension, the pains they describe indicate probable serious heart disease. Some people with diabetes expressed deep worry and loss of hope, saying that 'thoughts are more bothersome than the illness'. Wellbeing among people with diabetes was described in two perspectives: Those who view diabetes as a 'static' condition think that they cannot attain wellbeing while those who view it as a 'dynamic' condition think that with consistent treatment and healthy lifestyles, they can be well. While many participants perceive future wellbeing as important, people without diabetes are less concerned about it than those with diabetes. Inadequate knowledge about diabetes, drug stock-outs in health facilities, unaffordable healthier food, and contradictory information were cited as barriers to future wellbeing in people with diabetes. CONCLUSIONS: To make type 2 diabetes prevention relevant to healthy people, health education messages should link current lifestyles to future wellbeing. Diabetes patients need counselling support, akin to that in HIV care, to address deep worry and loss of hope.

A situational analysis of priority disaster hazards in Uganda: findings from a hazard and vulnerability analysis.

BACKGROUND: Most countries in sub-Saharan Africa have not conducted a disaster risk analysis. Hazards and vulnerability analyses provide vital information that can be used for development of risk reduction and disaster response plans. The purpose of this study was to rank disaster hazards for Uganda, as a basis for identifying the priority hazards to guide disaster management planning. METHODS: The study as conducted in Uganda, as part of a multi-country assessment. A hazard, vulnerability and capacity analysis was conducted in a focus group discussion of 7 experts representing key stakeholder agencies in disaster management in Uganda. A simple ranking method was used to rank the probability of occurance of 11 top hazards, their potential impact and the level vulnerability of people and infrastructure. RESULTS: In-terms of likelihood of occurance and potential impact, the top ranked disaster hazards in Uganda are: 1) Epidemics of infectious diseases, 2) Drought/famine, 3) Conflict and environmental degradation in that order. In terms of vulnerability, the top priority hazards to which people and infrastructure were vulnerable were: 1) Conflicts, 2) Epidemics, 3) Drought/famine and, 4) Environmental degradation in that order. Poverty, gender, lack of information, and lack of resilience measures were some of the factors promoting vulnerability to disasters. CONCLUSION: As Uganda develops a disaster risk reduction and response plan, it ought to prioritize epidemics of infectious diseases, drought/famine, conflics and environmental degradation as the priority disaster hazards.

A descriptive overview of the burden, distribution and characteristics of epidemics in Uganda.

BACKGROUND: Although Uganda is a high burden country for epidemics of infectious diseases, the pattern of epidemics has not yet been adequately documented. The purpose of this study was to describe the distribution, magnitude and characteristics of recent epidemics in Uganda, as a basis for informing policy on priorities for targeted prevention of epidemics. METHODS: Qualitative and quantitative data was collected from the Epidemiological Surveillance Division of the Ministry of Health and the African Field Epidemiology Network through key informant interviews and a documents review. RESULTS: Acute outbreaks that have occurred since 2002 are: Cholera, Meningitis, Malaria, Viral Hemorrhagic Fevers (Ebola, Marburg), arboviruses (yellow-fever), Anthrax, Hepatitis E, Measles, Polio, Influenza A viruses, dysentery and other diarrheal diseases. Chronic outbreaks include: Propagated epidemics of cholera, head nodding disease, Hepatitis B, Hepatitis E, HIV and Typhoid Fever. Thirty-one districts had a high incidence of cholera. Most of the epidemic prone diseases are preventable through appropriate behavior change and sanitation measures. However, current focus is mainly on prevention, low focus on prevention. Community involvement in resilience and early detection is inadequate. CONCLUSION: Uganda has a high burden of preventable epidemic prone diseases. There is need to invest in surveillance, early detection and sustainable prevention through appropriate technology and behavior change involving individuals, families, communities and policy makers.

Use of the Automated Disaster and Emergency Planning Tool in developing district level public health emergency operating procedures in three East African countries.

BACKGROUND: Sub-Saharan Africa is vulnerable to several natural and man-made disasters. We used the CDC Automated Disaster and Emergency Planning Tool (ADEPT) to develop all-hazards disaster management plans at district level in three eastern African countries. METHODS: During July 2008-February 2011, we used the automated disaster and emergency planning tool to conduct training on disaster planning and management in the three east African countries namely Kenya, Tanzania and Uganda. We trained district disaster teams per country. We held 7 trainings in Tanzania, 8 in Uganda and 10 in Kenya respectively. The district disaster management teams trained comprised five district administrative personnel and a national Red Cross officer. The training took 5 days. RESULTS: A total of 100 districts teams (40 in Uganda and 35 in Kenya and Tanzania respectively) were trained using the ADEPT and consequently 100 district disaster response plans were developed during 2008-2011. A total 814 district disaster team members from these districts were trained. Our experience has shown that the Automated Disaster Emergency Planning Tool is a relatively quick, easy, practical, participatory and inexpensive approach to developing emergency operating plans at the sub-national (district) level. CONCLUSIONS: The ADEPT can be used relatively easily, quickly and inexpensively at the sub-national levels to develop emergency operating procedures to improve disaster management. Although the ADEPT enables district disaster response teams to generate their disaster response plans, the use of the ADEPT may be hampered by lack of computer skills and knowledge of MS computer programme by district personnel in resource limited settings.

Regional approach to building operational level capacity for disaster planning: the case of the Eastern Africa region.

BACKGROUND: The Eastern Africa region is regularly affected by a variety of disasters ranging from drought, to human conflict and population displacement. The magnitude of emergencies and response capacities is similar across the region. In order to strengthen public health disaster management capacities at the operational level in six countries of the Eastern Africa region, the USAID-funded leadership project worked through the HEALTH Alliance, a network of seven schools of public health from six countries in the region to train district-level teams. OBJECTIVES: To develop a sustainable regional approach to building operational level capacity for disaster planning. METHODS: This project was implemented through a higher education leadership initiative. Project activities were spear-headed by a network of Deans and Directors of public health schools within local universities in the Eastern Africa region. The leadership team envisioned a district-oriented systems change strategy. Pre-service and in-service curricula were developed regionally and district teams were formed to attend short training courses. Project activities began with a situational analysis of the disaster management capacity at national and operational levels. The next steps were chronologically the formation of country training teams and training of trainers, the development of a regional disaster management training curriculum and training materials, the cascading of training activities in the region, and the incorporation of emerging issues into the training curriculum. An evaluation model included the analysis of preparedness impact of the training program. RESULTS: The output from the district teams was the creation of individual district-level disaster plans and their implementation. This 4-year project focused on building operational level public health emergency response capacity, which had not previously been part of any national program. Use of the all-hazard approach rather than a scenario-based contingency planning led to the development of a standardized curriculum for training both in-service and pre-service personnel. Materials developed during the implementation phases of the project have been incorporated into public health graduate curricula in the seven schools. This systems-based strategy resulted in demonstrable outcomes related to district preparedness and university engagement in disaster management. CONCLUSION: University partnerships are an effective method to build district-level disaster planning capacity. Use of a regional network created a standardized approach across six countries.

A descriptive analysis of the institutional frameworks for disaster management in Uganda: structures, functions and gaps.

BACKGROUND: There is insufficient documentation of the institutional frameworks for disaster management and resilience at different levels in sub-Saharan Africa. The objective of this study was to describe the institutional framework for disaster management in Uganda, and to identify actionable gaps at the different levels. METHODS: This was part of a multi-country assessment in which 6 countries in Eastern Africa developed and applied a common tool. The assessment was qualitative in nature employing a mixed methods approach including review of documents, interviews with key informants from agencies involved in disaster management in Uganda, group discussions with stakeholder and synthesis meetings of the assessment team. FINDINGS: The Office of the Prime Minister is the lead agency for disaster management, but management of disasters of a technical nature is devolved to line ministries (e.g. epidemics by the Health Ministry and Epizootics by the Agriculture Ministry). A new policy spells out disaster management structures at national, district, sub-county, and village levels. Key challenges included coordination, more focus on prevention than risk reduction, differences in capacity between sectors and inadequate inter-sectoral collaboration. The new policy and structures have not yet been rolled out to districts and sub-district levels, and districts lack a line item budget for disaster capacity building. CONCLUSIONS: The institutional framework for disaster management in Uganda needs to be strengthened at all levels through initiation of the relevant structures, training, and resource allocation so that they develop disaster management plans.