High uptake of COVID-19 vaccines among healthcare workers in urban Uganda.

OBJECTIVES: The aim of the study was to describe the facilitators, barriers to and level of uptake of COVID-19 vaccines among healthcare workers in primary healthcare facilities in an urban setting in Uganda. MATERIALS AND METHODS: We conducted a cross-sectional study among HCWs in private and public health facilities in Entebbe municipality between July 2021 and August 2021. Data was collected using a structured questionnaire that was shared, via an online link, to consented participants. Uptake of the vaccines among healthcare workers was analysed as proportions, and logistic regression was used to analyse barriers and facilitators to uptake of COVID-19 vaccines. RESULTS: The study enrolled 360 participants, with 61.7% (n = 222) females. A total of 236 (65.6%) healthcare workers had received at least one dose of COVID-19 vaccine, with higher uptake among females 64% (n = 151). Age above 40 years (OR 2.16), working in a government healthcare facility (OR 3.12), participating in COVID-19 vaccine related activities (OR 4.62), and having tested for SARS-COV-2 (OR 3.05) increased the odds of having been vaccinated. Working in small roadside clinics reduced the odds of being vaccinated by almost 70%, while HCWs in government health services were 3.1 times more likely to have been vaccinated. History of having cared for a COVID-19 patient and having a positive SARS-COV-2 test result did not influence the uptake of the vaccines in the study population. CONCLUSION: Vaccine uptake among HCWs was close to the World Health Organisation (WHO) recommended uptake of 70% by mid-2022.

Risk perception and usage of non-occupational post-exposure prophylaxis among fisherfolk in Ggulwe parish on the shores of Lake Victoria in central Uganda.

Background: The use of non-occupational post-exposure prophylaxis (nPEP) to prevent HIV acquisition among those exposed as an approach to HIV prevention has expanded in Uganda. Although there are increased efforts to avail nPEP services among most at-risk populations, the usage of nPEP medicines remains low. Therefore, this study examined the risk perception and usage of non-occupational post-exposure prophylaxis (nPEP) among fisherfolk in the Ggulwe fishing parish, Bussi sub-county, Wakiso district. Methods: A cross-sectional study among adults was carried out from October 2020 to January 2021 in Ggulwe parish, Bussi sub-county, Wakiso district, to examine the usage of nPEP and factors influencing the usage. Data were collected using semi-structured questionnaires, and key informants' interviews were conducted among healthcare providers and the local leadership. The quantitative data were summarized using bivariate and multivariate logistic regression, while the qualitative data were analyzed thematically to enrich the quantitative results. Results: Overall, 248 fisherfolk encountered an event that required the use of nPEP, and of these, 55/248 (22.2%) were able to use nPEP to prevent them from acquiring HIV. The usage of nPEP among adults in the Bussi sub-county, Wakiso district, was associated with not knowing that HIV can be prevented using nPEP medicines (AOR:0.1, 95% CI 0.03-0.36, p < 0.001), lack of knowledge of the existence of nPEP (AOR: 0.3, 95% CI 0.13-0.76, p = 0.01), the perception that nPEP can effectively prevent HIV infection after exposure (AOR 0.0586, 95% CI: 0.0177-0.1944, p < 0.001), and the community's opinion affecting the willingness to take nPEP (AOR 0.1924, 95% CI: 0.0380-0.9727, p = 0.0462). Conclusion: The usage of nPEP among fisherfolk was low (22.2%). The low usage of nPEP was associated with a lack of knowledge and awareness about nPEP. This effort to improve the usage of nPEP should include community sensitization and HIV infection prevention using nPEP to raise awareness about HIV infection exposures and the risk of HIV infection during non-occupational exposures.

Maternal health-seeking behaviour of peri-urban women living with disability in Busiro South Health sub District, Wakiso district, Uganda: a community-based study.

Aim: We examined the maternal healthcare-seeking behaviour of peri-urban women with disabilities in Busiro South Health Sub District, Wakiso district, Uganda. Methods: This community-based cross-sectional study. Data were collected using semi-structured questionnaires and focus group discussions. Chi-square was used to test for differences, and logistic regression to determine factors associated with maternal health-seeking behaviour at a 5% level of significance. Content analysis was used to analyse qualitative data. Results: A total of 182 women with disabilities were enrolled. Overall, 150 (82.3%) of the disabled women had attended ANC and 147 (80.8%) had delivered their babies at a health facility. The participants' mean age was 31.9±7.8years (range: 17-49 years). ANC attendance among disabled women was influenced by maternal age 18-30 years (p = 0.010), number of times a disabled woman was pregnant (p = 0.003), parity (p = 0.018), a normal delivery (p = 0.048), receiving financial support from friends of partners (p < 0.001), distance of less than 5KM to the health facility (p = 0.024), friendliness of the health care providers (p=0.030) and availability of health providers (p < 0.001). Conclusion: There is an urgent need for a multi-sectoral approach to better healthcare-seeking behaviour.

Prevalence and associated factors of intestinal parasitic infections among HIV clients attending Masaka Regional Referral Hospital, Uganda.

Introduction: infection with Human Immune deficiency Virus (HIV) increases the risk of opportunistic infections, which aggravates life-long complications. We report the prevalence and the associated factors of intestinal parasites among HIV infected clients attending anti-retroviral therapy (ART) clinic at Masaka Regional Referral Hospital, in Uganda. Methods: this was a cross-sectional study that purposefully enrolled 410 HIV infected clients. Stool samples were macroscopically assessed, and analyzed using wet preparations, Formol ether concentration and Modified Ziehl Neelsen (ZN) techniques to identify cysts and ova of intestinal parasites. Further, a questionnaire was used to obtain data on socio-demographic, hygiene and immunologic markers. Logistic regression analysis was used to determine the associated factors of intestinal parasitic infection. Results: of the 410 adult HIV sero-positive clients enrolled, 58.0% (238/410) were females. Participants mean age was 26.8 years, (range of 18-59 years). The prevalence of intestinal parasites was 49/410 (11.95%; 95% confidence interval: 10.3 - 14.7). Intestinal parasites isolated were Giardia lamblia (N=10, 20.4%), strongloides stercolaris (N=4, 8.2%), and modified ZN showed Cryptosporidium species (N=35, 71.4%). Hand washing, history of not deworming in the previous 1 year, deteriorating HIV clinical stage and unprotected open water sources were the associated factors. Conclusion: this study reports a high prevalence of opportunistic intestinal parasites. As these are neglected tropical infections, early detection and exploration of the associated factors is key to their proper management.

Differential Self-Reported Determinants to Antiretroviral Therapy Adherence: Findings from Caregivers of Children Under Five Years Living with Human Immunodeficiency Virus Infection Attending Al-Sabah Hospital, South Sudan.

AIM/OBJECTIVE: This study explored the caregivers' self-reported determinants of antiretroviral therapy (ART) adherence among children under five years living with human immunodeficiency virus (HIV) infection attending Al-Sabah Hospital, South Sudan. METHODS: A cross-sectional study of 126 caregivers of HIV-infected children under five years was conducted at Al-Sabah Hospital, South Sudan. Data were collected using an interviewer-administered questionnaire. The self-reported adherence was measured as a binary variable using binary logistic regression. Only variables that were significant at bivariate analysis were analyzed at multivariate level and interpreted using the odds ratios (p< 0.05). RESULTS: Out of 126 caregivers with HIV-infected children, 38 (30.2%) did not adhere to ART. Of the proportion that adhered to ART (88, 69.8%), 49 (55.7%) were male. Most of the children (52, 59.1%) were above two years, but under five years. Fifty (56.8%) of those who adhered had completed 3 months on ART, and the majority were at WHO stage-1 of HIV infection. Analysis of the determinants indicated that children's duration on ART (p=0.001), type of ART regimen (single, double or triple therapy) (p=0.065), type of work done by the caregiver to earn a living (p-value 0.003), time a child was initiated on ART (p=0.002), caregiver-child relationship (p=0.002), caregiver-spousal support (p=0.019), type of support obtained whether monetary or not (p=0.000), when the child was started on ART (p=0.004), the person administering ART (p=0.010), the type of ARVs administered (p=0.001), the caregiver detecting ART side effects (p=0.000), types of adverse effects suffered by the child (p=0.043), time of receiving ART (p=0.047), use of western medicine (p=0.043), healthcare cadre (p=0.002), the kind of attention the healthcare provider offered (p=0.015), and improvements in quality of HIV services (p=0.001) were significantly associated with ART adherence. CONCLUSION: The study findings indicated that ART adherence among HIV-infected children under five years was suboptimal. This will necessitate continuous engagement and education of caregivers on the prominence of adhering to ART.

Quality of Life among Obstetric Fistula Patients at Kitovu Mission Hospital: A Health Facility-Based Cross-Sectional Study in Masaka District, Uganda.

BACKGROUND: Obstetric fistula (OF) remains a silent neglected maternal challenge associated with devastating life consequences. Living with OF presents far-reaching physical, social, psychosocial, and emotional concerns, which negatively impact a woman's quality of life. This study evaluated the quality of life among obstetric fistula patients in Masaka district, Uganda. METHOD: A cross-sectional study was conducted among 63 women diagnosed with OF at Kitovu Mission Hospital. Data were collected using a questionnaire, observation, in-depth interviews, and focus group discussions. Data were analyzed at univariate, bivariate, and multivariate levels, where the ordinal logistic regression model was applied. The qualitative data was transcribed and analyzed using qualitative content analysis. RESULTS: Majority (87%) of the women diagnosed with OF reportedly had a poor quality of life. Bivariate analysis indicated that level of education (P < 0.001), employment status (P < 0.001), energy for everyday life (P < 0.001), capacity to work (P < 0.001), satisfaction with personal relationships (P < 0.001), feelings of loneliness (P < 0.001), negative feelings (P = 0.002), and self-confidence (P < 0.001) were significantly associated with good QoL. Multivariate analysis showed increased odds of good QoL increased among women with self-confidence (OR = 32.320; CI = 2.019-517.467), formal education (OR = 9.9497; CI = 1.075-92.048), women who did not experience difficulties in mobility (OR = 19.144; CI = 0.149-2456.770), and women who were satisfied with their personal relationships (OR = 5.785; CI = 0.447-74.824). CONCLUSION: A holistic fistula treatment approach is required that takes into consideration all aspects of life to address the consequences of obstetric fistula to realize improved quality of life among patients.

The financing of stand-alone palliative Care Services in Uganda: analysis of the implications for sustainability.

BACKGROUND: Sustainable funding is key for ensuring the quality and coverage of palliative care services. This study examined the sources of funding for stand-alone palliative care services in Uganda as well as their services financial sustainability plans. METHODS: Researchers conducted a cross sectional survey of all stand-alone palliative care organizations that have operated for five or more years. Researchers administered a questionnaire survey and interviews on the audited financial statements, services provided and sustainability plans. RESULTS: Nine of the stand-alone palliative care organizations surveyed had operated for five to 25 years. 93% of the funding for palliative care services comes from donations; while 7% is from income generating activities. 94% of the donations are from external sources. The Government of Uganda's major contribution is in the form of medicines, training and payment of taxes. All the organizations had good financial records. Six of the fifteen Hospices/palliative care providers had sustainability plans included in their operational manuals. The older organizations (those that had been operational for more than 10 years) had better resource mobilization capacity and strategies. CONCLUSION: The majority of stand-alone palliative care organizations in Uganda are largely donor funded. They have considerable financial sustainability and fund-raising capacity. Government support is in the form of medicines and training. Based on this study findings, the capacity of the stand-alone palliative care services to raise funds should be increased. The Government of Uganda should include palliative care in the national health system and increase funding for these services.

Assessment of the diagnostic performance of TrueHb® point-of-care hemometer compared with Sysmex i3 analyzer among patients at International Hospital Kampala, Uganda.

Aim/Objective: To assess the diagnostic performance of TrueHb® point-of-care (POC) hemometer compared with Sysmex i3 analyzer at International Hospital Kampala, Uganda. Materials and methods: We analyzed ethylenediaminetetraacetic acid blood samples to estimate hemoglobin (Hb) levels using parallel testing with TrueHb® hemometer and Sysmex i3 analyzer. Data were analyzed to ascertain the diagnostic performance of the test assays using the Bland and Altman method. Sensitivity, specificity, positive and negative predictive values were calculated. Results: The study enrolled 402 patients; of these, 156 (38.8%) were males. The average Hb levels were 8.7±1.8 and 13.3±2.6 g/dL for the anemic and nonanemic patients, respectively. One hundred and fifty-five participants were anemic, giving anemia prevalence of 38.56% (95% CI: 35.17-40.38). The mean difference of the TrueHb® and Sysmex i3 assays was 2.2219 (SD 1.07915), and the two devices did not show a difference in their measurements (t=-2.407, p-value 0.017, 95% CI: -0.095-0.010). Further, they showed a significant level of agreement (t=41.281; 95% CI: 2.1161-2.3277) and intraclass correlation coefficients (ICC=0.793). The sensitivity, specificity, positive and negative predictive values were 100.00%, 51.01%, 55.16% and 100.00%, respectively. The average performance turnaround time (TAT) for the TrueHb® hemometer was 2.46 mins (95% CI: 2.37-2.55). Conclusion: TrueHb® POC hemometer is an accurate POC for Hb estimation with a good performance agreement with the Sysmex i3 analyzer. This, coupled with its utility aspects, makes it a good diagnostic tool in a high anemia burden and low-resource setting.

Laboratory assessment of SD Bioline HIV/Syphilis Duo Kit among pregnant women attending antenatal clinic Mayuge Health Center III, East central Uganda.

OBJECTIVE: Efforts to dual eradication of mother-to-child transmission of human immune deficiency virus (HIV) and syphilis have improved in the previous decades. This has however been hindered by limited validation studies. A cross-sectional study was conducted among adult pregnant women attending antenatal care clinic at Mayuge Health Center III. Two milliliters of venous blood were collected into Ethylene di-amine tetra acetic acid vacutainers, and tested for HIV and syphilis using the SD Bioline HIV/Syphilis Duo assay, and the national HIV and syphilis testing algorithm. Sensitivity and specificity were calculated for the Duo Kit against the gold standards within 95% confidence intervals. RESULTS: Three hundred and eighty-two (382) participants were enrolled. Their mean age was 25.8 years. The prevalence of HIV was 1.8% (95% confidence interval 1.23-2.41); while that of syphilis was 2.1% (95% confidence interval 1.81-2.54), and the dual infection was 0.52% (95% confidence interval 0.37-0.92). The sensitivity and specificity of the SD Bioline HIV/Syphilis Duo assay were all 100.0% (95% confidence interval 99.5 to 100.0 and 98.6 to 100.0, respectively). The performance of the SD Bioline HIV/Syphilis Duo Kit was optimal, reassuring its aptness for use, and favorable qualities to a limited resource setting.

Performance of Epidemic Preparedness and Response Committees to Disease Outbreaks in Arua District, West Nile Region.

The Epidemic Preparedness and Response Committees (EPPRCs) are at the heart of preventing outbreaks from becoming epidemics by controlling the spread. Evidence-based information regarding factors associated with the performance of EPPRCs in preparedness and response to disease outbreaks is needed in order to improve their performance. A cross-sectional study involving 103 EPPRC members was carried out in Arua district, West Nile region, between the months of July and December 2014. Data were collected using a structured questionnaire, and the chi-square test was used to establish associations. Forty-eight percentage of EPPRC members showed a moderate level of preparedness, and only 39.8% of them had a moderate level of response. The performance drivers of preparedness and response were dependent on presence of a budget (χ2 = 10.281, p=0.002), availability of funds (χ2 = 5.508, p=0.019), adequacy of funds, (χ2 = 11.211, p=0.008), support given by health development partners (χ2 = 19.497, p=0.001), and motivation (χ2 = 20.065, p < 0.001). Further, membership duration (χ2 = 13.776, p=0.001) and respondent cadre (χ2 = 12.538, p=0.005) had a significant association. Based on these findings, there is a big gap in the preparedness and response ability, all of which are dependent on the financial gap to the Committees. To this, funding for preparedness and response is a critical aspect to respond and contain an outbreak.

To test or not: occurrence of sickle cell trait and assessment of the awareness toward its screening among patients attending Magale Health Center IV, Namisindwa District, Eastern Uganda.

PURPOSE: To evaluate the occurrence of sickle cell trait (SCT), assess patient awareness and evaluate the performance of a sickle cell hemoglobin-S (dithionate-qualitative solubility) point-of-care test among patients seeking care at Magale Health Center IV, Namisindwa District, Eastern Uganda. MATERIALS AND METHODS: We conducted a cross sectional study, in which we consecutively enrolled participants aged ≥18 years at Magale Health Center IV. Four milliliters of EDTA blood were collected by venipuncture and screened for SCT using solubility testing, and confirmed with hemoglobin (Hb) electrophoresis at Central Public Health Laboratory (CPHL), Kampala, Uganda. A structured questionnaire was used to assess participants' awareness of SCT. Data were presented as proportion, and measurements of diagnostic test performance were calculated. RESULTS: We enrolled 242 participants, of these 58.7% (N = 142) were females. Their mean age was 26.4 years (range 18-49). Of the 242 participants, 11, who represent 4.5% (95% CI: 3.3-5.9), tested positive. The sensitivity, specificity, positive predictive value and negative predictive value of the rapid sickle cell test were 63.64%, 100%, 100% and 98.30%, respectively. There was knowledge gap regarding sickle cell awareness. CONCLUSION: The occurrence of SCT was high, and the point-of-care test showed a high diagnostic reliability. The risk of SCT is associated with genetic predisposition as indicated by Hb electrophoresis. Community sensitization is key to avert the associated risk of Hb defects.

Hematological abnormalities in HIV-antiretroviral therapy naïve clients as seen at an immune suppression syndrome clinic at Mbarara Regional Referral Hospital, southwestern Uganda.

AIM/OBJECTIVE: To assess the common hematological abnormalities among HIV-antiretroviral therapy (ART) naïve clients attending an immune suppression syndrome (ISS) clinic at Mbarara Regional Referral Hospital (MRRH), southwestern Uganda. PATIENTS AND METHODS: This was a cross-sectional study carried out during the months of March to August 2016 at the ISS clinic of MRRH. We collected approximately 4.0 mL of EDTA anticoagulated blood samples, which were assayed for complete blood count, CD4+ cell count and thin film examination. Correlation of the hematological abnormalities with CD4+ cell counts was done using correlation coefficient (r) and analysis of variance (F), and the p-value was set at ≤0.05. RESULTS: A total of 141 clients were enrolled. Of these, 67.38% (95/141) were anemic, 26.24% (40/141) had thrombocytopenia while 26.95% (38/141) had leucopenia. Of the 95 participants with anemia, 89.47% (85/95) presented with normocytic-normochromic anemia, 8.42% (8/95) with microcytic-hypochromic anemia and 2.11% (2/95) with macrocytic-hypochromic anemia. Anemia was not different across the several World Health Organization (WHO) stages of HIV infection disease progression (p>0.05). Statistically significant differences were present among participants with leucopenia (p<0.05). Also, leucopenia was more prevalent (11/38) among participants in WHO stage 4 of HIV infection. CD4+ cell counts correlated with thrombocytopenia (r=0.24, p<0.05) and leucopenia (r=0.15, p<0.05). CONCLUSION: People living with HIV/AIDS (PLWHIV/AIDS) ought to be routinely monitored and treated for the occurrence of hematological abnormalities. Early initiation of ART can help to prevent some hematological abnormalities.

The effect of knowledge on uptake of breast cancer prevention modalities among women in Kyadondo County, Uganda.

BACKGROUND: Breast cancer, the third most frequent cancer of women is preventable through knowledge on breast self-examination. Of the 44% of women diagnosed with breast cancer at the Uganda Cancer Institute, only 22% go for check-up in less than three months. This study explored the effect of breast cancer knowledge on the uptake of breast cancer prevention modalities among women in Kyadondo County, Uganda. METHODS: A household survey of women in Kyadondo County was conducted during June, 2014 to August, 2015. This involved studying in-depth using a questionnaire the level of breast cancer knowledge of the respondents. Data was analyzed using logistic regression model. Chi-square test was used to establish relationships between knowledge base factors and the uptake of breast cancer prevention modalities. RESULTS: This study has established an empirical relationship between uptake of breast cancer prevention modalities and source of information especially radio (OR 1.94 95% CI: 1.16-3.24), television (OR 1.82 95%CI: 1.14-2.93), awareness of breast cancer (OR 4.03 95%CI: 1.01-15.98), knowledge on how to reduce risk of breast cancer (OR 1.98 95% CI: 1.20-3.27), what reduces breast cancer acquisition (OR 2.75 95% CI: 1.42-5.35), how to check for signs of breast cancer especially through breast self-examination (OR 3.09 95% CI: 1.62-5.88), and other methods of breast cancer diagnosis in a health care set up. CONCLUSION: The women's level of breast cancer awareness as a primary prevention strategy was found wanting, and requires a boost through community health education.

Socio-demographic determinants and prevalence of Tuberculosis knowledge in three slum populations of Uganda.

BACKGROUND: Knowledge of tuberculosis has been shown to influence health seeking behaviour; and urban slum dwellers are at a higher risk of acquiring tuberculosis than the general population. The study aim was to assess knowledge of tuberculosis and identify the associated socio-demographic determinants, in order to inform tailored interventions for advocacy, communication and social mobilisation in three urban-slum communities of Uganda. METHODS: A cross-sectional survey of 1361 adults between April and October 2011. Data was analyzed by descriptive statistics. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) of potential determinants of tuberculosis (TB) knowledge were estimated by multivariable ordinal logistic regression using Stata 11.2 software. RESULTS: We found low knowledge of TB cause (26.7%); symptoms (46.8%), transmission (54.3%), prevention (34%) and free treatment (35%). Knowledge about TB treatment (69.4) and cure (85.1) was relatively high. Independent determinants of poor knowledge of TB in the multivariable analysis included (aOR, 95% CI) lack of formal education (0.56; 0.38 - 0.83, P = 0.004), unemployment (0.67; 0.49 - 0.90, P = 0.010) and never testing for HIV (0.69; 0.51 - 0.92, P < 0.012). Whilst, older age (1.73; 1.30 - 2.29, P < 0.001) and residing in Lira (2.02; 1.50 - 2.72, P < 0.001) were independent determinants of higher knowledge of TB. CONCLUSION: This study revealed deficiencies in the public health knowledge about TB symptoms, diagnosis and treatment among urban-slum dwellers in Uganda. Tuberculosis control programmes in similar settings should consider innovative strategies for TB education, advocacy, communication and social mobilisation to reach the youth, unemployed and less-educated; as well as those who have never tested for HIV.