Point of care obstetric ultrasound knowledge retention among mid-wives following a training program: a prospective cohort pilot study.

BACKGROUND: Obstetric ultrasound has become a routine part of antenatal care in many parts of the world including low income settings. However, there is a shortage of radiologists and sonographers to perform routine obstetric scans in many areas especially in the rural settings of low income countries, despite having equipment available to do this. As a result, Point of care ultrasound (POCUS) has been suggested to bridge this gap by training other health workers such as midwives to perform basic obstetric ultrasound as part of their clinical care. METHODS: It was a prospective cohort pilot study in which trained midwives in point of care obstetric ultrasound were followed up at 6 months post training to assess their knowledge retention. Eleven trained midwives were purposively selected and followed up for knowledge retention. These were trained for 6 weeks and were given a knowledge assessment immediately after training, then given an assessment at 6 months following training. Data was analyzed using SPSS. Wilcoxon signed rank test was used to compare assessments and perceived knowledge as well as Spearman correlation to test the relationship between the number of scans performed and exam assessments, knowledge and exam assessments, and number of scans and knowledge. RESULTS: There were eleven midwives, all female with an average age of 42.3 years. The mean exam score (out of 50) was 44.2 at the end of the training and 42.9 at 6-months follow up. The midwives demonstrated higher perceived knowledge at the end of the training when compared to the 6-months follow up. However, this perceived higher knowledge was not statistically significant when correlated with the exam scores either at the end of the training or at the follow up of 6 months. CONCLUSION: This pilot study has demonstrated that training midwives in point of care obstetric ultrasound can result into acceptable levels of knowledge retention that assist the midwives to apply this knowledge when making routine clinical decisions in relation to pregnant women.

Adult Computed Tomography examinations in Uganda: Towards determining the National Diagnostic Reference Levels.

INTRODUCTION: Diagnostic Reference Levels (DRLs), typically set at the 75th percentile of the dose distribution from surveys conducted across a broad user base using a specified dose-measurement protocol, are recommended for radiological examinations. There is a need to develop and implement DRLs as a standardisation and optimisation tool for the radiological protection of patients at Computed Tomography (CT) facilities. METHODS: This was a retrospective cross-sectional study conducted in seven (7) different CT scan facilities in which participants were recruited by systematic random sampling. The study variables were dose length product (DLP) and volume-weighted CTDI (CTDIvol) for the radiation doses for head, chest, abdomen and lumbar spine CT examinations. The DRLs for CTDIvol and DLP were obtained by calculating the 3rd quartiles of the radiation doses per study site by anatomical region. The national diagnostic reference levels were determined by computation of DRLs using the 75th centile of the median values. RESULTS: A total of 574 patients were examined with an average age of 47.1 years. For CTDIvol estimates; there was a strong positive significant relationship between the CTDIvol and examination mAs (rs = 0.9017, p-value < 0.001), and reference mAs (rs = 0.0.7708, p-value < 0.001). For DLP estimates; there was a moderate positive significant relationships between DLP and total mAs (rs = 0.6812, p-value < 0.001), reference mAs (rs = 0.5493, p-value < 0.001). The DRLs were as follows; for head CT scan - the average median CTDIvol was 56.02 mGy and the DLP was 1260.3 mGy.cm; for Chest CT, the CTDI volume was 7.82 mGy and the DLP was 377.0 mGy.cm; for the abdomen CT, the CTDI volume 12.54 mGy and DLP 1418.3 mGy.cm and for the lumbar spine 19.48 mGy and the DLP was 843 mGy.cm, respectively. CONCLUSION: This study confirmed the need to optimize the CT scan parameters in order to lower the national DRLs. This can be achieved by extensive training of all the CT scan radiographers on optimizing the CT scan acquisition parameters. Continuous dose audits are also advised with new equipment or after every three years to ensure that values out of range are either justified or further investigated.

Perceptions of orthopaedic medicine students and their supervisors about practice-based learning: an exploratory qualitative study.

BACKGROUND: Practice-based learning is crucial in forming appropriate strategies for improving learning among the medical students that support the country's understaffed health sector. Unsatisfactory learning consequently results in poor performance of students and poor quality of health care workforce in the long run. Exploring the perceptions about the current practice-based learning system and how to improve is thus vital. This study set out to explore the perceptions of Orthopaedic medicine students and their supervisors about practice-based learning at a tertiary training hospital. METHODS: This was an exploratory phenomenological qualitative study that involved in-depth interviews among 10 Orthopedic students during their rotation in the emergency ward of Mulago hospital and 6 of their supervisors. Interviews were audio-recorded, transcribed, and then imported into Atlas ti 8.3 for analysis. The data were coded and grouped into themes relating to perceptions of practice-based learning, general inductive analysis was used. The general inductive approach involved condensing the raw textual data into a brief and summary format. The summarized format was then analyzed to establish clear links between the perceptions of practice-based learning and the summary findings derived from the raw data. RESULTS: The mean age of the students was 23 ± 1.5 years. Four out of the six supervisors were Orthopaedic officers while the remaining two were principal Orthopaedic officers, four out of the six had a university degree while the other two were diploma holders. The main themes arising were hands-on skills, an unconducive learning environment, the best form of learning, and having an undefined training structure. Particularly, the perceptions included the presence of too many students on the wards during the rotation, frequent stock-outs of supplies for learning, and supervisors being overwhelmed caring for a large number of patients. CONCLUSION: Barriers to satisfactory practice-based learning were overcrowding on the wards and insufficient training materials. To improve practice-based learning, adequate learning materials are required and the number of students enrolled needs to be appropriate for the student - supervisor ratio.

Evaluation of a competency based medical curriculum in a Sub-Saharan African medical school.

BACKGROUND: Medical schools in Sub-Saharan Africa have adopted competency based medical education (CBME) to improve the quality of graduates trained. In 2015, Makerere University College of Health Sciences (MaKCHS) implemented CBME for the Bachelor of Medicine and Bachelor of Surgery (MBChB) programme in order to produce doctors with the required attributes to address community health needs. However, no formal evaluation of the curriculum has been conducted to determine whether all established competencies are being assessed. OBJECTIVE: To evaluate whether assessment methods within the MBChB curriculum address the stated competencies. METHODS: The evaluation adopted a cross-sectional study design in which the MBChB curriculum was evaluated using an Essential Course Evidence Form (ECEF) that was developed to collect information about each assessment used for each course. Information was collected on: (1) Assessment title, (2) Description, (3) Competency domain (4) Sub-competency addressed, (5) Student instructions, and (6) Grading method/details. Data were entered into a structured Access data base. In addition, face-to-face interviews were conducted with faculty course coordinators. RESULTS: The MBChB curriculum consisted of 62 courses over 5 years, focusing on preclinical skills in years 1-2 and clinical skills in years 3-5. Fifty-nine competencies were identified and aggregated into 9 domains. Fifty-eight competencies were assessed at least one time in the curriculum. Faculty cited limited training in assessment as well as large student numbers as hindrances to designing robust assessments for the competencies. CONCLUSION: CBME was successfully implemented evidenced by all but one of the 59 competencies within the nine domains established being assessed within the MBChB curriculum at MaKCHS. Faculty interviewed were largely aware of it, however indicated the need for more training in competency-based assessment to improve the implementation of CBME.

Specialty career preferences among final year medical students at Makerere University College of health sciences, Uganda: a mixed methods study.

BACKGROUND: Uganda has an imbalanced distribution of the health workforce, which may be influenced by the specialty career preferences of medical students. In spite of this, there is inadequate literature concerning the factors influencing specialty career preferences. We aimed to determine the specialty career preferences and the factors influencing the preferences among fifth year medical students in the School of Medicine, Makerere University College of Health Sciences (MakCHS). METHODS: A sequential explanatory mixed methods study design with a descriptive cross-sectional study followed by a qualitative study was used. A total of 135 final year medical students in MakCHS were recruited using consecutive sampling. Self-administered questionnaires and three focus group discussions were conducted. Quantitative data was analysed in STATA version 13 (StataCorp, College Station, Tx, USA) using descriptive statistics, chi-square tests and logistic regression. Qualitative data was analysed in NVIVO version 12 (QRS International, Cambridge, MA) using content analysis. RESULTS: Of 135 students 91 (67.4%) were male and their median age was 24 years (IQR: 24, 26). As a first choice, the most preferred specialty career was obstetrics and gynecology (34/135, 25.2%), followed by surgery (27/135, 20.0%), pediatrics (18/135, 13.3%) and internal medicine (17/135, 12.6%). Non-established specialties such as anesthesia and Ear Nose and Throat (ENT) were not selected as a first choice by any student. Female students had 63% less odds of selecting surgical related specialties compared to males (aOR = 0.37, 95%CI: 0.17-0.84). The focus group discussions highlighted controlled lifestyle, assurance of a good life through better financial remuneration and inspirational specialists as facilitators for specialty preference. Bad experience during the clinical rotations, lack of career guidance plus perceived poor and miserable specialists were highlighted as barriers to specialty preference. CONCLUSION: Obstetrics and Gynecology, Surgery, Pediatrics and Internal Medicine are well-established disciplines, which were dominantly preferred. Females were less likely to select surgical disciplines as a career choice. Therefore, there is a need to implement or establish career guidance and mentorship programs to attract students to the neglected disciplines.

A health care professionals training needs assessment for oncology in Uganda.

BACKGROUND: Cancer incidence and mortality in sub-Saharan Africa are increasing and do account for significant premature death. The expertise of health care providers is critical to downstaging cancer at diagnosis and improving survival in low- and middle-income countries. We set out to determine the training needs of health care providers for a comprehensive oncology services package in selected hospitals in Uganda, in order to inform capacity development intervention to improve cancer outcomes in the East African region. METHODS: This was a cross-sectional survey using the WHO Hennessey-Hicks questionnaire to identify the training needs of health workers involved in cancer care, across 22 hospitals in Uganda. Data were captured in real time using the Open Data Kit platform from which the data was exported to Stata version 15 for analysis using the Wilcoxon signed-rank test and Somers-Delta. RESULTS: There were 199 respondent health professionals who were predominately female (146/199, 73.37%), with an average age of 38.97 years. There were 158/199 (79.40%) nurses, 24/199 (12.06%) medical doctors and 17/199 (8.54%) allied health professionals. Overall, the research and audit domain had the highest ranking for all the health workers (Somers-D = 0.60). The respondent's level of education had a significant effect on the observed ranking (P value = 0.03). Most of the continuing medical education (CME) topics suggested by the participants were in the clinical task-related category. CONCLUSION: The "research and audit" domain was identified as the priority area for training interventions to improve oncology services in Uganda. There are opportunities for addressing the identified training needs with an expanded cancer CME programme content, peer support networks and tailored training for the individual health care provider.

Knowledge, attitudes and practices of faculty on mentorship: an exploratory interpretivist study at a sub-Saharan African medical school.

BACKGROUND: Mentorship has become a routine part of undergraduate training in health professions education. Although many health professions training institutions have successfully incorporated faculty-student mentorship in their formal training, many others especially in Sub-Saharan Africa have not fully embraced this. Institutionalized mentorship programmes are effective methods of enhancing student learning experiences. Faculty, who are the mentors have an active role to play in driving the mentorship agenda and ensure that students benefit from this important activity. The aim of this study was to explore the knowledge, attitudes and practices of faculty about student mentorship at Makerere University College of Health Sciences. METHODS: It was an exploratory qualitative study using interviewer-administered semi-structured questionnaires. The study participants included faculty at Makerere University College of Health Sciences. Thematic analysis was used to analyse the data using pre-determined themes. RESULTS: Four themes were identified: 1) Knowledge of mentorship, 2) Attitude towards mentorship, 3) Practice of mentorship and 4) Improving the mentorship process. Majority of the faculty reported being less knowledgeable on mentorship regardless of seniority. The level of knowledge seemed to influence the practice of mentorship. Despite the observed knowledge gap, all faculty demonstrated a positive attitude to participate in mentoring. CONCLUSION: Faculty demonstrated a positive attitude towards mentorship despite the knowledge gap of mentorship identified. Continuous faculty development in mentorship as well as using peer mentorship were identified as key in sustaining the mentorship programme.

An exploration of undergraduate medical students' satisfaction with faculty support supervision during community placements in Uganda.

INTRODUCTION: To produce health professionals who are oriented towards addressing community priority health needs, the training in medical schools has been transformed to include a component of community-based training. During this period, students spend a part of their training in the communities they are likely to serve upon graduation. They engage and empower local people in the communities to address their health needs during their placements, and at the same time learn from the people. During the community-based component, students are constantly supervised by faculty from the university to ensure that the intended objectives are achieved. The purpose of the present study was to explore student experiences of support supervision from university faculty during their community-based education, research and service (COBERS placements) and to identify ways in which the student learning can be improved through improved faculty supervision. METHODS: This was a cross-sectional study involving students at the College of Health Sciences, Makerere University, Uganda, who had a community-based component during their training. Data were collected using both questionnaires and focus group discussions. Quantitative data were analyzed using statistical software and thematic approaches were used for the analysis of qualitative data. RESULTS: Most students reported satisfaction with the COBERS supervision; however, junior students were less satisfied with the supervision than the more senior students with more experience of community-based training. Although many supervisors assisted students before departure to COBERS sites, a significant number of supervisors made little follow-up while students were in the community. Incorporating the use of information technology avenues such as emails and skype sessions was suggested as a potential way of enhancing supervision amidst resource constraints without faculty physically visiting the sites. CONCLUSIONS: Although many students were satisfied with COBERS supervision, there are still some challenges, mostly seen with the more junior students. Using information technology could be a solution to some of these challenges.

Emotional and Psychological Experiences of Nursing students caring for Dying Patients: A phenomenology study at Mulago National Hospital, Uganda.

Introduction: Caring for dying patients is associated with psychological trauma, strong emotions and enormous stress for nursing staff and nursing students who are relied on by patients and relatives in such difficult situations. Although nurses have an ability of self-control and calm approach towards death, there are still some emotions they need to "work through". Research studies have documented limited exposure of nursing students to end-of-life care and inadequate understanding of the psychological and emotional experiences they encounter during clinical placements. This study explored the psychological and emotional experiences of Ugandan student nurses on caring for the dying patients at Mulago national referral hospital during clinical placement. Methods: A qualitative phenomenological study was conducted among fifteen undergraduate nursing students of Makerere University in clinical placement at Mulago hospital. An In-depth interview guide was used to gather data on nursing students' emotional and psychological experiences and coping mechanisms. Data was audio recorded, verbatim transcribed and thematically analyzed using Atlas. ti version 6 software. Results: The nursing students emotional and psychological experiences when caring for dying patients were emerged into two themes; (1) Psychological and emotional reactions, (2) Coping mechanisms. The sub themes were; anger, anxiety and depression which is triggered by a combination of issues of pressure from relatives, failure to save the dying patient, thoughts of wasted efforts to reverse the dying process, limited resources, limited technical and emotional support. The students cope by seeking help from peers, engagement in problem solving, distancing from patients, spirituality and engaging in personal stress reducing activities. Conclusion: Insights from this study provide educators with a snapshot of student encounters, emotions, and coping strategies when facing dying patients and their families. Nursing students experience various negative emotional and psychological stressors triggered by a combination of issues that need to be addressed during care of dying patients. However, they devise different coping mechanisms to continue with provision of necessary end of life care as the clinical placement contributes to their learning, experience and builds confidence among student nurses.

Optometry students' experiences of their clinical training: A qualitative study in a low- resource setting.

Background: There is a gradual increase in the number of optometry education programs in low resource settings yet there is limited knowledge on optometry students' experiences of their clinical training. Therefore, the purpose of this study was to explore the optometry students' experiences of their clinical learning environment at a national referral and teaching hospital within a low resource setting. Methods: The study adopted a qualitative design using face to face in-depth interviews to explore experiences of the participants. All 16 optometry students in fourth-year at university were purposefully recruited into the study. Data was collected at the end of the students' clinical training at the eye clinic of a national referral and teaching hospital. Interviews were audio recorded and transcribed for analysis using an inductive thematic approach. Results: Two themes, learning at the eye clinic and organization of the eye clinic, were identified to represent participants' experiences. Each theme had three sub themes. Conclusion: The students' experiences in a clinical learning environment take a transformative nature from initial hesitancy and feelings of inferiority, anxiety, uncertainty and nervousness to increased confidence and active engagement. Future studies should compare optometry students' experiences in lower-level health units to those in national referrals hospitals.

Point of care obstetric ultrasound training for midwives and nurses: implementation and experiences of trainees at a rural based hospital in Sub-saharan Africa: a qualitative study.

BACKGROUND: Point of care ultrasound training has been successfully implemented in some settings. This has been done due to a shortage of radiology human resource gap especially in the rural areas of low-resource settings. The purpose of the study was to implement a point of care obstetric ultrasound training program for midwives and nurses and explore their experiences following the training at a rural based hospital in Uganda. METHODS: It was an exploratory qualitative study with some elements of implementation research design involving midwives and nurses that had undergone obstetric ultrasound training at Kiwoko hospital, a rural-based hospital in Uganda. Purposive sampling was used to select twenty-five midwives and nurses. These participants underwent a 6-weeks training in point of care obstetric ultrasound. Following the training, in-depth interviews were conducted to obtain the experiences of the participants. RESULTS: The training was conducted by qualified radiologists and sonographers and it involved both didactic sessions and rigorous practical and clinical demonstrations and eventually real-time scanning of the women. Three key themes emerged from the interviews: (1) Gaining important obstetric ultrasound skills, (2) Improving management of pregnant women and (3) Positive for task-shifting. CONCLUSION: The point of care obstetric ultrasound training program was successfully implemented at Kiwoko Hospital. The trainees reported positive experiences from the training and while only conducted at one rural health facility, the overwhelmingly positive experience from trainees underscores the importance of point of care obstetric ultrasound in delivering imaging services.

Continuing professional development training needs for primary care doctors in central Uganda.

BACKGROUND: Continuing professional development (CPD) activities relevant to medical doctors and their patients should be informed by current assessed training needs. The CPD provision is expected to improve the quality of professional practice and ethics. However, the Uganda Medical and Dental Practitioners' Council still receives about 40 reports of malpractice every month. AIM: The study aimed to describe the CPD training needs of doctors working in public primary care facilities in central Uganda. SETTING: The district health system of central Uganda comprised 10 General Hospitals (GH) and 37 Health Center IVs (HC IVs) with a staffing norm of six and two doctors, respectively. METHODS: This was a cross-sectional survey of 100 doctors working in public primary care facilities using the World Health Organization (WHO) Hennessy-Hicks questionnaire. Descriptive statistics of the importance, current performance, and training need of each skilled activity were calculated. Content analysis was applied to data from the open-ended questions. RESULTS: The response rate was 91%, majority were males, 80 (87.9%) from 7 GHs and 24 HC IVs with an average age of 37.9 years. The domain with the highest CPD training need for the doctors was research and audit, with a mean score (standard deviation [s.d.]) of 1.94 (±1.69), followed by administration 1.58 (±1.61) and clinical tasks 1.28 (±1.29). The clinical tasks domain had the most suggested CPD topics. CONCLUSION: Research and audit and clinical tasks were identified as important domains for CPD training for doctors in this setting.Contribution: The results give insight into CPD training needs of primary care doctors and guide various CPD providers.

Carotid Doppler findings among patients admitted with stroke in two tertiary care facilities in Uganda: A Hospital-based Cross-sectional Study.

Background: Carotid Atherosclerotic Disease (CAD) Doppler findings including carotid artery stenosis, thickened intima media thickness, and high-risk atherosclerotic plaques are associated with increased risk of stroke and symptomatic cerebrovascular disease. However, few studies have explored these Doppler characteristics among stroke patients in Africa. This study, therefore, investigates these carotid artery Doppler characteristics among stroke patients in Uganda. Methods: A hospital-based cross-sectional study of 95 stroke patients attending two national referral hospitals in Uganda between March and July 2022. Following the caption of their sociodemographic and clinical characteristics, they underwent Doppler sonography of the extracranial carotid arteries using a standard carotid Doppler protocol. Multivariate logistic regression was used to determine factors associated with abnormal carotid Doppler parameters (i.e., carotid intima-media thickness, carotid stenosis). Results: The mean age of the study participants was 61 ± 13 years with 60% (57/95) of the participants being male. Most participants had an ischemic stroke (67%), hypertension (76.4%), and used alcohol (58.9%). The prevalence of significant carotid stenosis in participants with ischemic stroke was 12.5% (8/64) (i.e., 7.8% had severe carotid stenosis and 4.7% had moderate stenosis). The prevalence of high carotid intima media thickness (CIMT) and atherosclerotic plaques were 31.6% (30/95) and 26.3% (25/95), respectively. Most atherosclerotic plaques were echogenic. Age above 60 years (adjusted odds ratio [aOR] = 5.2, 95% Confidence Interval [CI]:1.97-14; p < 0.010), high low-density lipoprotein cholesterol (aOR = 4.2, 95% CI: 1.29-8.79; p = 0.013) increased the likelihood of having abnormal CIMT. Conclusion: The burden of carotid atherosclerotic disease is increasing among stroke patients in Uganda. Large-scale epidemiological studies are needed to further profile the disease in high risk populations.

Typical Diagnostic Reference Levels of Common Indications for Computed Tomography Scans Among Adult Patients in Uganda: a Cross-sectional Study.

Background: Medical exposure to ionizing radiation has increased due to an increase in the number of computerized tomography (CT) scan examinations performed. The International Commission on Radiological Protection (ICRP) recommends indication-based diagnostic reference levels (IB-DRLs) as an effective tool that aids in optimizing CT scan radiation doses. In many low-income settings, there is a lack of IB-DRLs to support optimization of radiation doses. Objective: To establish typical DRLs for common CT scan indications among adult patients in Kampala, Uganda. Methodology: A cross sectional study design was employed involving 337 participants enrolled from three hospitals using systematic sampling. The participants were adults who had been referred for a CT scan. The typical DRL of each indication was determined as the median value of the pooled distribution of CTDIvol (mGy) data and the median value of the pooled distribution of total DLP (tDLP)(mGy.cm) data from three hospitals. Comparison was made to anatomical, and indication based DRLs from other studies. Results: 54.3% of the participants were male. The following were typical DRLs for: acute stroke (30.17mGy and 653mGy.cm); head trauma (32.04mGy and 878mGy.cm); interstitial lung diseases/ high resolution chest CT scan (4.66mGy and 161mGy.cm); pulmonary embolism (5.03mGy and 273mGy.cm); abdominopelvic lesion (6.93mGy and 838mGy.cm) and urinary calculi (7.61mGy and 975mGy.cm). Indication based total Dose Length Product (tDLP) DRLs was lower than tDLP DRLs of a whole anatomical region by 36.4% on average. Most of the developed typical IB-DLP DRLs were lower or comparable to values from studies in Ghana and Egypt in all indications besides urinary calculi while they were higher than values in a French study in all indications besides acute stroke and head trauma. Conclusion: Typical IB-DRLs is a good clinical practice tool for optimization of CT doses and therefore recommended for use to manage CT radiation dose. The developed IB-DRLs varied from international values due to differences in selection of CT scan parameters and standardization of CT imaging protocols may narrow the variation. This study can serve as baseline for establishment of national indication-based CT DRLs in Uganda.

Optimal utilization of prevention of mother-to-child transmission of HIV services among adolescents under group versus focused antenatal care in Eastern Uganda.

BACKGROUND: Group antenatal care (G-ANC), an alternative to focused ANC (F-ANC), involves grouping mothers by gestational and maternal age. In high-income countries, G-ANC has been associated with improved utilization of health care services like Prevention of Mother to Child Transmission (PMTCT) of HIV services. Some low-resource countries with poor utilization of health care services have piloted G-ANC. However, there is limited evidence of its efficiency. We, therefore, compared G-ANC versus F-ANC with regards to optimal utilization of PMTCT of HIV services and assessed associated factors thereof among adolescent mothers in eastern Uganda. We defined optimal utilization of PMTCT of HIV services as the adolescent being up to date with HIV counseling and testing. If found HIV negative, subsequent timely re-testing. If found HIV positive, initiation of antiretroviral therapy (ART) under option B plus for the mother. While for the infant, it entailed safe delivery, testing, feeding, and appropriate HIV chemotherapy. METHODS: From February to April 2020, we conducted a cross-sectional study among 528 adolescent mothers in four sites in eastern Uganda. We assessed the optimal utilization of PMTCT of HIV services among adolescent mothers that had attended G-ANC versus F-ANC at the post-natal care or immunization clinics. We also assessed the factors associated with optimal utilization of PMTCT of HIV services among these mothers. RESULTS: Optimal utilization of PMTCT was higher among those in G-ANC than in F-ANC (74.7% vs 41.2, p-0.0162). There was a statistically significant association between having attended G-ANC and optimal utilization of PMTCT [PR = 1.080, 95%CI (1.067-1.093)]. Other factors independently associated with optimal utilization were; having a partner that tested for HIV [PR = 1.075, 95%CI (1.048-1.103)], trimester of first ANC visit: second trimester [PR = 0.929, 95%CI (0.902-0.957)] and third trimester [PR = 0.725, 95%CI (0.616-0.853)], and the health facility attended: Bugembe HCIV [PR = 1.126, 95%CI (1.113-1.139)] and Jinja regional referral hospital [PR = 0.851, 95%CI (0.841-0.861]. CONCLUSIONS: Adolescent mothers under G-ANC had significantly higher optimal utilization of PMTCT of HIV services compared to those under F-ANC. We recommend that the Ministry of Health considers widely implementing G-ANC, especially for adolescent mothers.

Evaluation of community based education and service courses for undergraduate radiography students at Makeree University, Uganda.

INTRODUCTION: The Faculty of Medicine, Makerere University, is the oldest health professionals' training institution in East Africa. It has been training health professionals since 1924. In 2001, a bachelors degree in radiography commenced. After a curriculum review, the university's longstanding traditional curriculum was converted to a problem based learning curriculum with a focus on Community Based Education and Service (COBES). As a component of COBES, radiography, medical, nursing, dentistry and pharmacy students are sent to community health facilities where they are expected to participate in community services and other primary healthcare activities. This study was designed to obtain radiography teachers' and students' opinions of the significance and relevance of this community based training to radiography training. METHODS: Cross-sectional descriptive study. RESULTS: Both students and teachers (91.4%) affirmed the community training to be significant and relevant to radiography training. In total, 71.4% of the students had participated in X-ray services and 39.2% in ultrasound services during COBES; and 68.6% of the students reported the need to be better prepared for the COBES training. CONCLUSION: Both students and teachers confirmed COBES to be relevant to Ugandan radiography training.