Gaps in measles vaccination coverage in Kasese district, Western Uganda: results of a qualitative evaluation.

BACKGROUND: Despite the availability of a highly effective vaccine, measles remains a substantial public health problem in many countries including Uganda. In this study, conducted between June-August 2020 following a local outbreak, we sought to explore the factors that could affect measles vaccination coverage in rural western Uganda. METHODS: We conducted a descriptive study using qualitative data collection approaches in the Kasese district. The research team utilized purposive sampling to identify and select participants from the public health sector and district government. We conducted key informant interviews (KII) and one focus group discussion (FGD). Responses were recorded using portable electronic devices with the FGD and KII guide installed. Interviews were conducted at the health centre and district headquarters. Data was coded and analysed using ATLAS.ti version 8 software through deductive thematic analysis to identify key themes. RESULTS: Barriers to measles vaccination identified in this study were premised around six themes including: (i) availability of supplies and stock management, (ii) health worker attitudes and workload, (iii) financing of vaccination outreach activities, (iv) effectiveness of duty rosters (i.e., health workers' working schedules), (v) community beliefs, and (vi) accessibility of healthcare facilities. Respondents reported frequent vaccine supply disruptions, lack of resources to facilitate transportation of health workers to communities for outreach events, and health centre staffing that did not adequately support supplemental vaccination activities. Furthermore, community dependence on traditional medicine as a substitute for vaccines and long distances traveled by caregivers to reach a health facility were mentioned as barriers to vaccination uptake. CONCLUSIONS: Health system barriers limiting vaccination uptake were primarily logistical in nature and reflect inadequate resourcing of immunization efforts. At the same time, local beliefs favouring traditional medicine remain a persistent cultural barrier. These findings suggest an urgent need for more efficient supply management practices and resourcing of immunization outreaches in order to achieve the Uganda Ministry of Health's targets for childhood immunization and the prevention of disease outbreaks.

Comparison of the efficacy of crude methanolic extracts of Cassia occidentalis and Euphorbia hirta with levamisole-HCL against gastrointestinal nematodes of economic importance to goat production in Uganda.

Natural compounds from medicinal plants provide safe and sustainable alternatives to synthetic anthelmintics. In this study, we assessed in vitro and in vivo anthelmintic activity of Cassia occidentalis (NH-A) and Euphorbia hirta (NH-B) and compared it with levamisole-HCl. The shoots of NH-A and whole plant of NH-B were used to prepare extracts using 70% methanol which were used in the in vitro and in vivo assays. In vitro assays of crude methanolic extracts (CMEs) of NH-A and NH-B on larvae of mixed gastrointestinal nematodes (GINs) of goats revealed mortalities of 95.7% (at 100 mg ml-1) and 98.1% (at 50 mgml-1) 24 h postexposure. In vivo assays of NH-A administered orally at doses of 100, 300, 900, and 2700 mg kg-1 bwt revealed dose- and time-dependent anthelmintic effects in goats experimentally infected with mixed species of GINs. NH-B exhibited similar properties when administered at doses of 50, 100, 200, and 400 mg kg-1 bwt. Both NH-A (900 mg kg-1 bwt) and levamisole (7.5 mg kg-1 bwt) achieved a 100% reduction in fecal egg count per gram (EPG) on day 21 and day 14 respectively posttreatment. NH-B (400 mg kg-1 bwt) achieved 93.1% and 86.1% reduction in fecal EPG 7 and 14 days postexposure respectively compared with 88.2% and 82.3% reduction with levamisole-HCl 7 and 14 days postexposure. Our results show that extracts of both plants can disrupt helminth lifecycles by suppressing the egg-laying capacity in adult worms but also kill their infective larvae. Future studies should aim at establishing synergies or antagonisms between the two plant extracts and further development for control of helminths in goats.