Implementation of high coverage mass rabies vaccination in rural Uganda using predominantly static point methodology.

Despite successful eradication programmes in many regions, rabies remains responsible for approximately 60,000 human deaths annually, and no country in Africa is rabies-free. Dogs are the principal reservoir of the virus in Africa and the World Health Organisation recommends that at least 70% of the dog population be vaccinated in order to break the transmission cycle. Most attempts at mass rabies vaccinations in Africa have failed to vaccinate high numbers of dogs at a high coverage. Successful studies have often used a door-to-door (DTD) approach, which is logistically challenging and expensive compared to a static point (SP) approach. Mission Rabies has successfully implemented a combined SP and DTD method in cities in India and Malawi. This campaign used a combined methodology in rural Uganda, starting with a SP campaign, followed by a DTD campaign, and then subsequent transect surveys to assess vaccination coverage. This was facilitated by the use of a smartphone application which recorded all vaccinations and survey responses along with their Global Positioning System location. A total of 4172 dogs were vaccinated in 7 days, attaining an estimated 88.4% coverage. This campaign is of particular note as 95.9% of the vaccinations were performed at SPs. The human-to-dog ratio was 4.9 with a mean dogs per house of 1.2. Most dogs were owned (93.7%). This demonstrates that high-number, high-coverage vaccination is achievable in rural Uganda and provides data that may refine future campaign approaches.

Demographic and sociocultural factors influencing contraceptive use in Uganda.

Bivariate and multivariate analyses of the influence of demographic and sociocultural factors on contraceptive knowledge, attitudes and practice among currently married respondents in Uganda show that: (1) contraceptive knowledge is widespread, even among women with no education; (ii) the majority of the respondents have favourable attitudes towards contraceptive use; (iii) the level of contraceptive use is low in comparison with knowledge and attitudes. Post-primary education, ethnicity, residence, the presence of the spouse in the household and discussion of family planning with spouse were strong predictors of knowledge and favourable attitudes towards contraception. Secondary or higher education, discussion of family planning with spouse and urban residence strongly influenced contraceptive use, but child mortality did not. The use of condoms as a behavioural change to avoid contracting HIV/AIDS was low. The results suggest that, particularly in rural areas, family planning services are not meeting the needs of potential clients.

PIP: Data from the 1988/89 Uganda Demographic and Health Survey was used to examine contraceptive knowledge, attitude, and usage among 3055 currently married Ugandan women. An estimated 20% of total population were not included in the sample due to areas of civil disorder. Greater knowledge about contraception was found among women with a secondary or higher education, among women with three or more surviving children, among urban women, and among women with husbands absent. Catholic women had less knowledge than Protestants and Muslims. More favorable attitudes toward contraceptive use were found among women aged 20 years and older. Women with a secondary or higher education were more likely to approve of contraceptive use. The Bantu, Nilo-hamites, and Hamites highly approved of contraception compared to Lilotics. Approval was greater among women who desired no more children. Women whose husbands lived away from home were more likely to approve of contraceptive use. 26.4% of women who had never had a child die had ever practiced family planning. 21.6% who had experienced a loss of a child had ever practiced family planning. Women who had married at the age of 20 years and older were more likely to have practiced family planning. Contraceptive use was 26.2% among women with three or more surviving children. 19.0% of women with no surviving children used contraceptives. Higher contraceptive use was associated with higher educational level, ethnicity (Banti and Nilo-hamite), women with husbands absent, and urban women. In the multiple classification analysis, findings showed that knowledge of contraceptive methods was strongly predicted by a woman's ethnic origin, educational attainment, discussion of family planning with a partner, place of residence, and age at first marriage. Significant determinants of approval of contraceptive use included husband-wife discussion of family planning, a woman's ethnic origin, educational level, fertility preference, religious affiliation, and number of surviving children. Ever use of contraception was significantly related to having secondary or higher education, ever discussed family planning with a spouse, urban residence, and the desire to stop childbearing. Traditional method use was related to women with no or only primary education. 22.0% of men in Kampala and 11.0% of rural men had ever used condoms, but only 8.4% used condoms as a prevention for AIDS.