Principles for task shifting hypertension and diabetes screening and referral: a qualitative study exploring patient, community health worker and healthcare professional perceptions in rural Uganda.

BACKGROUND: A shortage of healthcare workers in low- and middle-income countries (LMICs) combined with a rising burden of non-communicable diseases (NCDs) like hypertension and diabetes mellitus has resulted in increasing gaps in care delivery for NCDs. As community health workers (CHWs) often play an established role in LMIC healthcare systems, these programs could be leveraged to strengthen healthcare access. The objective of this study was to explore perceptions of task shifting screening and referral for hypertension and diabetes to CHWs in rural Uganda. METHODS: This qualitative, exploratory study was conducted in August 2021 among patients, CHWs and healthcare professionals. Through 24 in-depth interviews and ten focus group discussions, we investigated perceptions of task shifting to CHWs in the screening and referral of NCDs in Nakaseke, rural Uganda. This study employed a holistic approach targeting stakeholders involved in the implementation of task shifting programs. All interviews were audio-recorded, transcribed verbatim, and analyzed thematically guided by the framework method. RESULTS: Analysis identified elements likely to be required for successful program implementation in this context. Fundamental drivers of CHW programs included structured supervision, patients' access to care through CHWs, community involvement, remuneration and facilitation, as well as building CHW knowledge and skills through training. Additional enablers comprised specific CHW characteristics such as confidence, commitment and motivation, as well as social relations and empathy. Lastly, socioemotional aspects such as trust, virtuous behavior, recognition in the community, and the presence of mutual respect were reported to be critical to the success of task shifting programs. CONCLUSION: CHWs are perceived as a useful resource when task shifting NCD screening and referral for hypertension and diabetes from facility-based healthcare workers. Before implementation of a task shifting program, it is essential to consider the multiple layers of needs portrayed in this study. This ensures a successful program that overcomes community concerns and may serve as guidance to implement task shifting in similar settings.

Effect of soaking, boiling and frying on selenium content of major african fresh foods.

Selenium is an essential trace element that is crucial for normal functioning of human body systems and it is obtained from diet or dietary supplements. The concentration of selenium (Se) varies from soil-to-soil and therefore in various food types. We profiled the selenium concentration in the major African fresh foods and studied the effect of boiling, frying and overnight soaking on their selenium content. The foods were taken to the chemistry laboratory, processed for determining selenium concentration in the fresh foods and then subjected to the various treatments before determining their Se concentration using an atomic absorption spectrometer. Among the fresh foods studied, pumpkin seeds were found to have the highest Se concentration (109.25 ± 0.125 parts per billion (ppb)), while Irish potatoes had the lowest (16.25 ± 0.125 ppb). In most fresh foods studied, boiling and frying had the effect of reducing the Se concentration, except in yams that showed an increased concentration after frying. Overnight soaking of matooke (plantain bananas) and beans showed an effect of causing a considerable reduction in the Se concentration from 36.375 ± 0.281 ppb and 59.125 ± 0.031 ppb to 14.03 ± 0.441 ppb and 24.375 ± 0.281 ppb, respectively. Boiling and frying cause a significant reduction in Se concentration of most African fresh foods. Overnight soaking of matooke and beans caused further reduction in the selenium concentration of the fresh foods. This implies that people who pre-soak their food before cooking it are likely to lose more selenium than those who do not soak and may be more likely to suffer from Se deficiencies.