Barriers to use of antiretroviral drugs in Rakai district of Uganda.

BACKGROUND: About 75% of people living with HIV/AIDS (PHAs) who need antiretroviral therapy have no access to these drugs in low-income countries. OBJECTIVE: To investigate the barriers to use of ART in Rakai district of Uganda. METHODS: We interviewed 38 key informants and 384 PHAs. Data was collected on: education/mobilization for ART, sources of information for ART, beliefs regarding ART, social support, use of alternative medicine, stigma/discrimination towards PHAs, distance to ART centres, transport costs to ART centres, waiting time, and on suggestions as how to improve the use of ART. RESULTS: The major barriers mentioned regarding use of ART included: inadequate mobilization, long waiting time at ART treatment centres, high cost of transport to reach ART centres, stigma/discrimination towards PHAs and inadequate number of health workers to attend to PHAs. CONCLUSIONS: Access to antiretroviral therapy could be ameliorated by: improving community education using innovative approaches such as through music, dance and videos, increasing the number of providers who are able to provide ART as through engagement of non health professionals in ART care, bringing ART nearer to where people live and instituting measures aimed at reducing stigma/discrimination such as through involvement of PHAs in demystisfying HIV/AIDS.

Barriers to use of Antiretroviral Drugs in Rakai District of Uganda

Background: About 75of people living with HIV/AIDS (PHAs) who need antiretroviral therapy have no access to these drugs in low-income countries. Objective: To investigate the barriers to use of ART in Rakai district of Uganda Methods: We interviewed 38 key informants and 384 PHAs. Data was collected on: education/mobilization for ART; sources of information for ART; beliefs regarding ART; social support; use of alternative medicine; stigma/discrimination towards PHAs; distance to ART centres; transport costs to ART centres; waiting time; and on suggestions as how to improve the use of ART. Results: The major barriers mentioned regarding use of ART included: inadequate mobilization; long waiting time at ART treatment centres; high cost of transport to reach ART centres; stigma/discrimination towards PHAs and inadequate number of health workers to attend to PHAs. Conclusions: Access to antiretroviral therapy could be ameliorated by: improving community education using innovative approaches such as through music; dance and videos; increasing the number of providers who are able to provide ART as through engagement of non health professionals in ART care; bringing ART nearer to where people live and instituting measures aimed at reducing stigma/discrimination such as through involvement of PHAs in demystisfying HIV/AIDS

"False Teeth ""Ebiino"" and Millet Disease ""Oburo"" in Bushenyi District of Uganda"

"Background:""False teeth"" (Ebiino) and ""Millet disease"" (Oburo; Tea-tea) have been reported in Uganda and other countries in Sub-Saharan Africa. These two perceived diseases are commonly reported in children under-five years of age. Anecdotal and published evidence suggests that these conditions are associated with moderate to severe childhood diseases such as malaria; pneumonia and diarrhoea and that most health seeking behaviour for the conditions is from traditional healers. Objectives:To estimate how common the 2 perceived diseases (false teeth and millet disease) are and describe health seeking behaviour for the two diseases. Methods: We did a cross-sectional survey using an interviewer administered questionnaire with closed and open questions in Bushenyi district; Uganda. The participants included 215 heads of households or their spouses obtained by cluster random sampling of 30 villages. Participants answered questions regarding occurrence of false teeth and millet disease disease in the household; treatment sought for false teeth and millet disease; perceived causes of false teeth and millet disease and about social economic situation of the household. Results: More than one in two of the households had a child less than five years who suffered from false teeth or millet disease in the last five years. More than 80of the respondents used traditional medicine alone or in combination with modern medicine to treat false teeth and or millet disease. Occurrence of false teeth and millet disease disease were favoured by low education status and not living in a house with cemented floor or having a brick wall. Use of traditional medicine was not associated with social economic conditions. Conclusions: The frequency of the perceived diseases false teeth and millet disease disease is high and may be attributed to low access to preventive and curative health services"

Factors influencing choice of delivery sites in Rakai District of Uganda

In order to understand factors influencing choice of delivery sites in Rakai district of south-western Uganda; eight focus group discussions based on the Attitudes-Social Influence-Self efficacy model were held with 211 women from 21 random cluster samples who had a delivery in the previous 12 months (from 2 June 1997). Forty four percent of the sample delivered at home; 17at traditional birth attendants's (TBA) place; 32at public health units; and 7at private clinics. Among the factors influencing choice of delivery site were: access to maternity services; social influence from the spouse; other relatives; TBAs and health workers; self-efficacy; habit (previous experience) and the concept of normal versus abnormal pregnancy. Attitudinal beliefs towards various delivery sites were well understood and articulated. Attendance of ante-natal care may discourage delivery in health units if the mothers are told that the pregnancy is normal. In order to make delivery safer; there is need to improve access to maternity services; train TBAs and equip them with delivery kits; change mother's self-efficacy beliefs; and involve spouses in education about safe delivery

National immunisation days for polio eradication in Uganda: did immunisation cards increase coverage?

OBJECTIVE: To analyse the effect of cards and of vitamin A supplementation on coverage for National Immunisation Days (NIDs). DESIGN: A retrospective ecological study. SETTING: A countrywide NIDs coverage before and after introduction of the NIDs cards and vitamin A supplementation in all districts of Uganda. METHODS: NIDs for polio eradication commenced in Uganda in 1996. Two rounds, one month apart are implemented yearly. During the second round of 1998 NIDs, cards were introduced nationally and vitamin supplementation was introduced in 24 of the 45 districts. We compared NIDs coverage before and after NIDs cards and NIDs coverage in districts that implemented vitamin A to those that did not. RESULTS: After introduction of NIDs cards, the national coverage rose from 97.7% to 106.9%, an increase of 9.2%. In those districts that implemented vitamin A supplementation, the NIDs coverage rose from 100.1% to 111.5%, an increase of 10.4%. In those districts that did not implement vitamin A, the NIDs coverage rose by 6.7% from 94.5% to 102.2%. Before the introduction of cards and vitamin A in 1996 and 1997, the NIDs coverage was between 92-96%. CONCLUSION: NIDs cards and vitamin A supplementation could have increased the NIDs national coverage.

PIP: A retrospective ecological study was carried out to analyze the effect of cards and vitamin A supplementation on coverage for National Immunization Days (NIDs) in Uganda. Commenced in 1996, NIDs for polio eradication in Uganda are implemented twice a year, one month apart. During the second round of 1998 NIDs, cards were introduced nationally and vitamin A supplementation was introduced in 24 of the 45 districts. NIDs coverage before and after the introduction of cards and NIDs coverage in districts implementing and those not implementing vitamin A supplementation were compared. After introduction of NID cards, the national coverage increased by 9.2% (from 97.7% to 106.9%). In those districts that implemented vitamin A supplementation, a 10.4% rise in NIDs coverage was noted (from 100.1% to 111.5%). NIDs coverage in those districts that did not implement vitamin A supplementation rose from 94.5% to 102.2%, an improvement of 6.7%. Based on these findings, it was concluded that NIDs cards and vitamin A supplementation could have increased the NIDs national coverage.