ABSTRACT
Even with global Sustainable Development Goals aimed at reducing poverty by reaching those furthest behind first and reducing inequalities within countries, regions like Karamoja continue to score low on many health indices. To understand the Karamoja context, we aimed to systematically describe the burden of disease in Nakaale, which is a hard-to-reach parish in Nakapiripirit District, through disaggregated data. This descriptive, cross-sectional study was conducted between January and December 2019. We relied on secondary data collected from all clients seen at Akisyon a Yesu Presbyterian Clinic's outpatient department in Nakaale. Data was extracted from Uganda's Health Management Information System records using Excel and exported to Stata for analysis. We labelled, categorised, and estimated frequencies and proportions for the variables. We estimated the means and medians for normally distributed or skewed variables respectively. A total of 14,685 observations, different diagnoses (n = 163) and residential locations or villages (n = 189) were extracted and included in the analysis. Nearly half (48.9%) of the clients were under the age of five years. Infectious diseases (42%), respiratory diseases (19%), and gastrointestinal and hepatic diseases (17%) were most commonly reported. While many clients (42%) reside in the sub-county where the health facility is located, a larger proportion (58%) came from further away, including 15% from outside of the local district. In conclusion, Akiyson a Yesu Presbyterian Clinic serves a very young population in a catchment area well beyond what is expected of a Health Centre II, in breadth of diagnoses, geographically, and in sheer numbers. Data gathered in this study will inform policy at the clinic, subcounty, and district levels enabling accurate health service delivery for the local context.
ABSTRACT
BACKGROUND: Drawing attention to home birth conditions and subsequent neonatal infections is a key starting point to reducing neonatal morbidity which are a main cause of mortality in sub-Saharan Africa. OBJECTIVES: To determine the proportion of respiratory, ophthalmic, and diarrhoeal infections in neonates; the proportion of mothers of neonates, following clean delivery practices; and to explore existing community practices during delivery and the neonatal period. METHODS: A descriptive, cross-sectional, exploratory study, including 10 questionnaires and five Key-Informant interviews, in rural Karamoja, Uganda. RESULTS: Post-delivery razor blade and string use was 90%, but clean delivery surface use only 30%, while 90% obtained bathing water for neonates from boreholes. No mothers washed hands after latrine-related activities compared with 83% for food-related activities. None delivered in health centres or with skilled birth attendants. Respiratory infections occurred in eight neonates, compared to two ophthalmic infections, and no diarrhoea. CONCLUSION: Use of clean delivery surfaces needs to be improved as well as washing after latrine-related activities. Diarrhoea was far less common than expected. Since rural Mother-Infant pairs spend the majority of their post-delivery time around the homestead, hygiene impacts neonatal infections to a large degree, possibly even more so than delivery practices.
