Task shifting in health service delivery from a decision and policy makers' perspective: a case of Uganda.

BACKGROUND: Documented evidence shows that task shifting has been practiced in Uganda to bridge the gaps in the health workers' numbers since 1918. The objectives of this study were to provide a synthesis of the available evidence on task shifting in Uganda; to establish levels of understanding, perceptions on task shifting and acceptability from the decision and policy makers' perspective; and to provide recommendations on the implications of task shifting for the health of the population in Ugandan and human resource management policy. METHODS: This was a qualitative study. Data collection involved review of published and unpublished literature, key informant interviews and group discussion for stakeholders in policy and decision making positions. Data was analyzed by thematic content analysis (ethical clearance number: SS 2444). RESULTS: Task shifting was implemented with minimal compliance to the WHO recommendations and guidelines. Uganda does not have a national policy and guidelines on task shifting. Task shifting was unacceptable to majority of policy and decision makers mainly because less-skilled health workers were perceived to be incompetent due to cases of failed minor surgery, inappropriate medicine use, overwork, and inadequate support supervision. CONCLUSIONS: Task shifting has been implemented in Uganda for a long time without policy guidance and regulation. Policy makers were not in support of task shifting because it was perceived to put patients at risk of drug abuse, development of drug resistance, and surgical complications. Evidence showed the presence of unemployed higher-skilled health workers in Uganda. They could not be absorbed into public service because of the low wage bill and lack of political commitment to do so. Less-skilled health workers were remarked to be incompetent and already overworked; yet, the support supervision and continuous medical education systems were not well resourced and effective. Hiring the existing unemployed higher-skilled health workers, fully implementing the human resource motivation and retention strategy, and enforcing the bonding policy for Government-sponsored graduates were recommended.

Assessing causal effects of early life-course factors on early childhood caries in 5-year-old Ugandan children using directed acyclic graphs (DAGs): A prospective cohort study.

OBJECTIVE: To estimate the effect of distal and proximal early life-course factors on early childhood caries (ECC) in 5-year-old Ugandan children, particularly focusing on the causal effect of exclusive breast feeding (EBF) on ECC using directed acyclic graphs (DAGs) for confounder selection. METHODS: This study had a nested prospective cohort design, focusing on 5 years of follow-ups of caregiver-children pairs from the PROMISE-EBF trial (ClinicalTrials.gov no: NCT00397150) conducted in 2011 in Eastern Uganda. Data were from recruitment interviews, 24-week, 2-year and 5-year follow-ups of a cohort of 417 mother-children pairs. Trained research assistants performed interviews with caregivers in the local language and ECC was recorded under field conditions using the World Health Organization's (WHO) decayed missing or filled teeth (dmft) index. Early life-course factors in terms of socio-demographic characteristics, EBF and other feeding habits were assessed at the various follow-ups. The outcome (ECC; dmft>0) was assessed at the 5-year follow-up. Causal diagrams as DAGs were constructed to guide the selection of confounding and collider variables to be included in or excluded from the final multivariable analysis. Negative binomial regression analyses were performed based on two comparative DAGs representing different causal models. RESULTS: Model 1 based on DAG 1, showed EBF to be a protective factor against ECC, with an IRR and 95% CI of 0.62 (0.43-0.91). According to Model 2 based on DAG 2, EBF and having both parents living together had protective effects: the corresponding IRRs and 95% CI were 0.60 (0.41-0.88) and 0.48 (0.25-0.90), respectively. CONCLUSIONS: Both plausible models indicated that being exclusively breastfed for 24 weeks had a protective causal effect against ECC. Further research, examining the unmeasured variables included in the DAGs is necessary to strengthen the present finding and allow stronger causal claims.

Knowledge, Attitudes and Perceptions of Secondary School Teenagers towards HIV Transmission and Prevention in Rural and Urban Areas of Central Uganda.

HIV/AIDS has remained a challenge in Uganda among adolescent despite the ABC strategy used globally to prevent HIV infection. The study assessed the knowledge, attitudes and perceptions of secondary school teenagers towards HIV transmission and prevention in rural and urban schools of central Uganda. A cross sectional study using self-administered questionnaires and structured interviews was used to collect data from adolescents in secondary schools in Kampala and Buikwe districts. Eight schools were randomly selected with 4 schools in each district. A total of 245 students from schools were recruited in the study with 120 and 125 students from urban Kampala and rural Buikwe district schools respectively. Data were analyzed using SPSS version 11. The results were expressed as percentages in a 2 × 2 tables. The mean age of the participants was 15.9 ± 2.5 years. Results showed that 95.1% participants had knowledge on HIV/AIDS in both urban and rural schools and 27.4% knew all the modes of HIV transmission. About 83.7% knew the ABC strategy for HIV prevention and 37.6% would talk about HIV/AIDS mainly with friends. For HIV cure, 62.0% of study participants reported non-cure and 24.9% were not sure. The remaining 13.1% of the study participants in both urban and rural schools reported that HIV can be cured. And the modes of curing HIV that were mentioned by participants included spiritual healing, transmitting it to others through sexual intercourse and that antiretroviral (ARVs) drugs can cure it as well as that it can be cured abroad. About 65.7% of participants reported recognition of one with HIV/ AIDS and by having red lips, being sickly; weight loss, skin rash and being very rich were mentioned. About 39.2% of the study participants mentioned that they cannot get infected with HIV and can't contract HIV at all and 18.4% believed that chances of getting HIV infection were high. On perception and attitude on condoms and their use, participants reported that it is a sign of mistrust, reduces sexual pleasures and they are embarrassing to buy. Majority of the participants in both urban and rural schools had some knowledge on HIV/AIDS and the ABC strategy for HIV prevention. However, there was a knowledge gap on the various modes of HIV transmission and prevention. There was misconception of the participants on HIV/AIDS cure, condom use and on the chances of contracting HIV. About the source of HIV/AIDS information, majority of the participants were getting information on HIV/AIDS from friends of which some information was misleading. This false information could be the reason for the increased HIV prevalence reported among the adolescents in the schools. Generally, participants had some knowledge on HIV/AIDS though they had knowledge gap on HIV transmission and prevention.

Prevalence and Factors Associated with Low Birth Weight among Teenage Mothers in New Mulago Hospital: A Cross Sectional Study.

The World Health Organization defines low birth weight (LBW) as a new born having a weight of less than 2,500 g at birth. Low birth weight is one of the major determinants of perinatal survival, infant morbidity and mortality as well as the risk of developmental disabilities and illnesses in future lives. WHO estimates that about 30 million low birth weight babies are born annually (23.4% of all births) and they often face short and long term health consequences. Whereas the global prevalence of LBW has slightly declined, the rate in many developing countries is still quite high. In Uganda, low birth weight among teenage mothers is a problem. Our study aimed to estimate the prevalence of and identify the factors associated with low birth weight among teenage mothers in New Mulago hospital. We conducted an analytical cross sectional study among teenage mothers who delivered from new Mulago Hospital Complex labour suite from August 2013 to August 2014. Trained interviewers, administered pre-tested questionnaires to consecutive mothers to obtain information on their socio-demographic characteristics, obstetric history and child factors. Odds ratios and P-values were calculated to determine the relationship between independent and dependent variables. We also used descriptive statistics for the quantitative data. A total of 357 teenage mothers were enrolled on the study. Their mean age was 18 years (Range 13-19), majority, 98.4% aged 15-19 years. The prevalence of LBW was 25.5%. Pre-term delivery (OR = 3.3032 P = 0.0001) and multiple pregnancies (OR = 0.165 P = 0.039) were associated with LBW. Malaria, young maternal age and ANC attendance were not associated with LBW. Child factors such as birth order, congenital anomalies and sex of the baby were also not associated with LBW. The prevalence of LBW is high among teenage mothers, pre-term delivery and multiple pregnancies were associated factors with LBW. Health professional's need to address teenage maternal health. Health workers should encourage teenage mothers to attend focused antenatal care as recommended by the Uganda ministry of Health. A specialized maternal facility centre that is friendly for adolescent/teenage mothers is advisable so as to improve on completion rates and capture high risk teenage mothers early.

Attendance and Utilization of Antenatal Care (ANC) Services: Multi-Center Study in Upcountry Areas of Uganda.

INTRODUCTION: Globally every year 529,000 maternal deaths occur, 99% of this in developing countries. Uganda has high maternal and neonatal morbidity and mortality ratios, typical of many countries in sub-Saharan Africa. Recent findings reveal maternal mortality ratio of 435:100,000 live births and neonatal mortality rate of 29 deaths per 1000 live births in Uganda; these still remain a challenge. Women in rural areas of Uganda are two times less likely to attend ANC than the urban women. Most women in Uganda have registered late ANC attendance, averagely at 5.5 months of pregnancy and do not complete the required four visits. The inadequate utilization of ANC is greatly contributing to persisting high rates of maternal and neonatal mortality in Uganda. This study was set to identify the factors associated with late booking and inadequate utilization of Antenatal Care services in upcountry areas of Uganda. METHOD: Cross-sectional study design with mixed methods of interviewer administered questionnaires, focus group discussions and key informant interviews. Data was entered using Epidata and analyzed using Stata into frequency tables using actual tallies and percentages. Ethical approval was sought from SOM-REC MakCHS under approval number "#REC REF 2012-117" before conducting the study. RESULTS: A total of four hundred one were enrolled with the majority being in the age group 20 - 24 years (mean age, 25.87 ± 6.26). Health workers played a great role (72.04%), followed by the media (15.46%) and friends (12.50%) in creating awareness about ANC. A significant number of respondents went to TBAs with reasons such as "near and accessible", "my husband decided", and "they are the only people I know". 37.63% of the respondents considered getting an antenatal Card as an importance of ANC. 71 (19.67%) respondents gave a wrong opinion (late) on booking time with reasons like demands at work, no problems during pregnancy, advised by friends, just to get a card, long distance and others didn't know. Almost half of the respondents never knew the recommended number of visits. Religion, occupation, level of education, and parity were found to influence place of ANC attendance, number of ANC visits and booking time. Husbands were necessary to provide financial support, accompany their wives ANC clinic, and ensure that they complete the visits. But their response was poor due to: fear of routine investigations and constrained economically. CONCLUSION: The study findings show the actual rural setting of ANC services attendance and utilization. Much sensitization has to be done specifically in these rural areas to empower pregnant women and their husbands as to improve ANC attendance and utilization.

Effect of Breastfeeding Promotion on Early Childhood Caries and Breastfeeding Duration among 5 Year Old Children in Eastern Uganda: A Cluster Randomized Trial.

BACKGROUND: Although several studies have shown short term health benefits of exclusive breastfeeding (EBF), its long term consequences have not been studied extensively in low-income contexts. This study assessed the impact of an EBF promotion initiative for 6 months on early childhood caries (ECC) and breastfeeding duration in children aged 5 years in Mbale, Eastern Uganda. METHODS: Participants were recruited from the Ugandan site of the PROMISE- EBF cluster randomised trial (ClinicalTrials.gov no: NCT00397150). A total of 765 pregnant women from 24 clusters were included in the ratio 1:1 to receive peer counselled promotion of EBF as the intervention or standard of care. At the 5 year follow-up, ECC was recorded under field conditions using the World Health Organization's decayed missing filled tooth (dmft) index. Adjusted negative binomial and linear regression were used in the analysis. RESULTS: Mean breastfeeding duration in the intervention and control groups (n=417) were 21.8 (CI 20.7-22.9) and 21.3(CI 20.7-21.9) months, respectively. The mean dmft was 1.5 (standard deviation [SD] 2.9) and 1.7 (SD 2.9) in the intervention and control groups, respectively. Corresponding prevalence estimates of ECC were 38% and 41%. Negative binomial regression analysis adjusted for cluster effects and loss-to-follow-up by inverse probability weights (IPW) showed an incidence-rate ratio (IRR) of 0.91 (95% CI 0.65-1.2). Comparing the effect of the trial arm on breastfeeding duration showed a difference in months of 0.48 (-0.72 to 1.7). CONCLUSION: PROMISE EBF trial did not impact on early childhood caries or breastfeeding duration at 5 years of age. This study contributes to the body of evidence that promotion of exclusive breastfeeding does not raise oral health concerns. However, the high burden of caries calls for efforts to improve the oral health condition in this setting. TRIAL REGISTRATION: ClinicalTrials.gov NCT00397150.

Characteristics of pyogenic odontogenic infection in patients attending Mulago Hospital, Uganda: a cross-sectional study.

BACKGROUND: Predisposing factors of pyogenic odontogenic infection include dental caries, pericoronitis, periodontitis, trauma to the dentition and the supporting structures or complications of dental procedures. The infections are usually polymicrobial involving normal endogenous flora. We characterised pyogenic odontogenic infection in patients attending Mulago Hospital, Uganda. RESULTS: Of the 130 patients, 62 (47.7%) were female. The most frequently involved fascial spaces were: the buccal, 52 (25.4%); submasseteric, 46 (22.4%) and the submandibular space, 36 (17.5%). Dental caries was the most prevalent predisposing factor, particularly of the lower third molar teeth. Viridans Streptococci Group and Staphylococcus aureus were the most frequent bacterial isolates: 23.5% and 19.4%, respectively. All Viridans Streptococci isolates were resistant to penicillin G, sulfamethoxazole/trimethoprim (cotrimoxazole), ampicillin and tetracycline, but susceptible to vancomycin. All Staphylococcus aureus strains were resistant to cotrimoxazole and ampicillin while retaining susceptibility to vancomycin, cefotaxime, linezolid, moxifloxacin and amoxicillin/clavulanate. Thirty five (26.9%) patients were HIV infected and the HIV status did not significantly influence the pattern of odontogenic infection. CONCLUSIONS: Dental caries was the most prevalent predisposing factor for pyogenic odontogenic infection. High prevalence of bacterial resistance to ampicillin and cotrimoxazole suggests the need for regular antibiotic susceptibility tests of isolates and rational use of antibiotics in the management of these infections. Prevention requires strengthening of oral health in the community.

Prevalence and factors associated with dental caries among children and adults in selected districts in Uganda.

OBJECTIVE: The aim was to determine the prevalence and factors associated with dental caries among adults and children in seven districts of Uganda. METHODS: Participants aged 11-13 (n=1230) and 35-44 years (n=648) were randomly selected from urban and rural areas of Gulu, Soroti, Jinja, Masaka, Kabale, Kabarole and Hoima districts. They were examined by 4 trained and calibrated dentists for dental caries using Decayed, Missing and Filled teeth index as described by World Health Organisation. RESULTS: Overall mean DMFT score was 0.73 for children and 4.71 for adults. Generally, there was a higher mean DMFT score in the rural (2.19) compared to urban areas (1.97). In all the districts, except Hoima, there was a higher mean DMFT score of children in rural compared to urban. In adults, similar trend was mainly registered in Masaka, Hoima and Gulu districts. Most participants (79.9%, n=1309) occasionally ate sugared snacks. Overall, 95% (n=1795) of the participants cleaned their teeth with plastic tooth brushes (71.7%) and chewing sticks (8.3%). CONCLUSION: Although the severity of dental caries was low, the disease was widespread in the study population. A high proportion of participants reported consumption of sugared snacks and drinks, which calls for oral health education.

Association between oral candidiasis and low CD4+ count among HIV positive patients in Hoima Regional Referral Hospital.

BACKGROUND: The aim of this study was to determine the prevalence of Human Immune Virus (HIV) related oral lesions and their association with Cluster of Differentiation 4 (CD4+) count among treatment naïve HIV positive patients. METHODS: This was a descriptive and analytical cross sectional study. Participants were 346 treatment naïve HIV positive adult patients. These were consecutively recruited from Hoima Regional Referral hospital between March and April 2012. Data collection involved interviews, oral examinations and laboratory analysis. RESULTS: A total of 168(48.6%) participants had oral lesions. The four commonest lesions were oral candidiasis (24.9%, CI = 20.6-29.7%), melanotic hyperpigmentation (17.3%, CI = 13.7-21.7%), kaposi sarcoma (9.3%, CI = 6.6-12.8%) and Oral Hairy Leukoplakia (OHL) (5.5%, CI = 3.5-8.4%). There was significant association between oral candidiasis and immunosuppression measured as CD4+ less than 350 cells/mm3 (OR = 2.69, CI = 1.608-4.502, p < 0.001). Oral candidiasis was the only oral lesion significantly predictive of immunosuppression (OR = 2.56, CI = 1.52-4.30, p < 0.001) with a Positive Predictive Value (PPV) of 48.2%, Negative Predictive Value (NPV) of 74.3%, 38.1% sensitivity and specificity of 81.4%. CONCLUSION: Oral candidiasis can be considered as a marker for immunesuppression, making routine oral examinations essential in the management of HIV positive patients.

A scoping study on task shifting; the case of Uganda.

BACKGROUND: Task shifting has been implemented in Uganda for decades with little documentation. This study's objectives were to; gather evidence on task-shifting experiences in Uganda, establish its acceptability and perceptions among health managers and policymakers, and make recommendations. METHODS: This was a qualitative study. Data collection involved; review of published and gray literature, and key informant interviews of stakeholders in health policy and decision making in Uganda. Data was analyzed by thematic content analysis. RESULTS: Task shifting was the mainstay of health service delivery in Uganda. Lower cadre of health workers performed duties of specialized health workers. However, Uganda has no task shifting policy and guidelines, and task shifting was practiced informally. Lower cadre of health workers were deemed to be incompetent to handle shifted roles and already overworked, and support supervision was poor. Advocates of task shifting argued that lower cadre of health workers already performed the roles of highly trained health workers. They needed a supporting policy and support supervision. Opponents argued that lower cadre of health workers were; incompetent, overworked, and task shifting was more expensive than recruiting appropriately trained health workers. CONCLUSIONS: Task shifting was unacceptable to most health managers and policy makers because lower cadres of health workers were; incompetent, overworked and support supervision was poor. Recruitment of existing unemployed well trained health workers, implementation of human resource motivation and retention strategies, and government sponsored graduates to work for a defined mandatory period of time were recommended.

'Many voices, one song': a model for an oral health programme as a first step in establishing a health promoting school.

Four health promoting (HP) schools were established in rural communities in Uganda by a joint Ugandan/Canadian university team. The model was based on a successful Canadian health promotion initiative designed to address poor oral health in Aboriginal children in rural and remote communities. Careful situation analysis, orientation of partner schools and collaborative development of educational materials and evaluation methodology preceded implementation. The intervention had three elements: inclusion of health topics by teachers in regular classroom activities; health education delivered by the university team to reinforce key educational concepts; and daily in-school tooth brushing to develop healthy practices. All children entering Grade 1 at four schools were recruited for 4 years; evaluation included year 1 pre-intervention and annual end-of-year data collection of quantitative and qualitative measures. Principal findings at 4 years included: an increase from baseline in the original cohort (n = 600) in those brushing at least once daily (p < 0.05) and before bed (p < 0.05); improved oral health (less 'bad breath', pain and absences for emergency dental treatment); more comprehensive health knowledge. Other positive observations were change in the schools' health culture; children sharing new health knowledge and advocating for health practices learned; and evolution of health promotion activity to address other community-identified issues following success with the initial oral health component. University faculty and students learned from participation in programme delivery and community-based educational opportunities. School-based health promotion using this oral health model was readily accepted, implemented, sustained and evaluated; all communities took ownership, and all schools continue their programmes. Addressing oral health through HP schools is novel in Africa, and several lessons learned are of potential value for similar health promotion initiatives in sub-Saharan Africa.

Videotaped interviews as a medium to enhance cross-cultural programme evaluation.

Evaluation is a required component of interventions. Written data are the predominant source. However, video recording is used in many applications to evaluate a range of encounters and practices. We report assessment of the role of videotaped interviews in programme evaluation. Interviews using a consistent script of open-ended questions were recorded during evaluation of an international child-health promotion programme in Uganda by individuals with basic training and equipment. Participants were a convenience sample of programme team members (six school teachers, and six Ugandan and 12 Canadian health-care trainees) who had completed the annual written evaluation questionnaire. Evaluators reviewed each participant's videotaped interview and questionnaire, content coded the responses against a criterion-based check list, documented how many times factual information was contributed on each question and compared the data. Videos were also assessed for strong positive or negative emotion. Videotaped interviews provided more comprehensive responses than written questionnaires, and were more accurate where mis-comprehension of question meaning occurred. The video interview, unlike the written questionnaire, allowed rephrasing for clarification. The video interview medium enhanced programme evaluation by providing more facts, greater insight into the effects of the interventions and clearer direction for future activity. Hence, video-recorded feedback has great potential value in applied research for comprehensive programme evaluation.

Patient satisfaction with services in outpatient clinics at Mulago hospital, Uganda.

OBJECTIVE: To identify factors associated with general satisfaction among clients attending outpatient clinics in a referral hospital in Uganda. DESIGN: Cross-sectional exit survey of patients and care-givers in selected outpatient clinics. SETTING: Seven outpatients' clinics at Mulago National Referral and Teaching Hospital. MAIN OUTCOME MEASURES: Mean score of clients' general satisfaction with health-care services. RESULTS: Overall the clients' general satisfaction was suboptimal. Average satisfaction was higher among clients with a primary or secondary education compared with none, those attending HIV treatment and research clinic compared with general outpatient clients, and returning relative to new clients. Conversely, satisfaction was lower among clients incurring costs of at least $1.5 during the visit, and those reporting longer waiting time (>2 h). Client's perceived technical competence of provider, accessibility, convenience and availability of services especially prescribed drugs were the strongest predictor of general satisfaction. CONCLUSIONS: This study highlights the important findings about outpatient services at Mulago hospital. The sub-optimal satisfaction scores for outpatient care strongly suggest that more could be done to assure that services provided are more patient centered. Significant factors including category of clinic visited, waiting time, costs incurred, accessibility of services and perceived providers' technical competence at this hospital should be explored by the Makerere University College of Health Sciences and Mulago hospital for potential improvements in quality of the health service delivered.

Oral Manifestations in HIV/AIDS-Infected Children.

OBJECTIVES: To assess factors influencing the distribution of oral manifestations in HIV/AIDS-infected children attending the Paediatric Infectious Disease Clinic in Mulago Hospital, Kampala. METHODS: This was a cross-sectional study comprising 237 children (males/females: 113/124) aged 1 to 12 years. The parents/guardians were interviewed to obtain demographic information, oral hygiene practices, dietary habits and health seeking behaviours as well as any medications taken. The children were clinically examined for oral lesions based on World Health Organization criteria with modifications. RESULTS: About 71.7% of the children cleaned their teeth. About 16.9% of the children had visited a dentist since birth, mainly for emergency care. One or more oral lesions were recorded in 73% of the children of whom 19.0% experienced discomfort during oral functions. Cervical lymphadenopathy, oral candidiasis and gingivitis were the most common soft tissue oral lesions: 60.8%, 28.3% and 19.0%, respectively. Except for dental caries, the overall frequency distribution of soft tissue oral lesions was significantly lower in children on highly active antiretroviral therapy (HAART) as compared to their counterparts not on HAART. The prevalence of dental caries in deciduous and permanent dentitions was 42.2% and 11.0%, respectively. Tooth brushing and previous visits to the dentist were indirectly and significantly associated with dental caries. About 5.9% (n=14) of the children had <200 CD3 + CD4 T-lymphocyte cells per µl of blood. CONCLUSIONS: The majority of the children had one or more oral lesions, particularly in the group not on HAART. Some of the lesions were associated with discomfort during oral functions.

Makerere University College of Health Sciences' role in addressing challenges in health service provision at Mulago National Referral Hospital.

BACKGROUND: Mulago National Referral Hospital (MNRH), Uganda's primary tertiary and teaching hospital, and Makerere University College of Health Sciences (MakCHS) have a close collaborative relationship. MakCHS students complete clinical rotations at MNRH, and MakCHS faculty partner with Mulago staff in clinical care and research. In 2009, as part of a strategic planning process, MakCHS undertook a qualitative study to examine care and service provision at MNRH, identify challenges, gaps, and solutions, and explore how MakCHS could contribute to improving care and service delivery at MNRH. METHODS: Key informant interviews (n=23) and focus group discussions (n=7) were conducted with nurses, doctors, administrators, clinical officers and other key stakeholders. Interviews and focus groups were tape recorded and transcribed verbatim, and findings were analyzed through collaborative thematic analysis. RESULTS: Challenges to care and service delivery at MNRH included resource constraints (staff, space, equipment, and supplies), staff inadequacies (knowledge, motivation, and professionalism), overcrowding, a poorly functioning referral system, limited quality assurance, and a cumbersome procurement system. There were also insufficiencies in the teaching of professionalism and communication skills to students, and patient care challenges that included lack of access to specialized services, risk of infections, and inappropriate medications.Suggestions for how MakCHS could contribute to addressing these challenges included strengthening referral systems and peripheral health center capacity, and establishing quality assurance mechanisms. The College could also strengthen the teaching of professionalism, communication and leadership skills to students, and monitor student training and develop courses that contribute to continuous professional development. Additionally, the College could provide in-service education for providers on professionalism, communication skills, strategies that promote evidence-based practice and managerial leadership skills. CONCLUSIONS: Although there are numerous barriers to delivery of quality health services at MNRH, many barriers could be addressed by strengthening the relationship between the Hospital and MakCHS. Strategic partnerships and creative use of existing resources, both human and financial, could improve the quality of care and service delivery at MNRH. Improving services and providing more skills training could better prepare MakCHS graduates for leadership roles in other health care facilities, ultimately improving health outcomes throughout Uganda.

Health promoting schools provide community-based learning opportunities conducive to careers in rural practice.

The World Health Organization conceived "health-promoting schools" as a means of providing the information and support systems necessary for the worldwide changes in behavior that are needed to improve health globally and decrease health care costs. We developed and evaluated a model of progressively implementing health-promoting schools with support from university medical school trainees in Canada and Uganda. The model uses oral health as a medium for establishing rapport and success around a topic with little stigma. The evaluation involved questionnaires of the Canadian trainees about practice intentions before and after involvement in the health-promoting schools to determine whether community-based learning in health-promoting schools resulted in more trainees planning to work in rural areas or underserved countries. We found that Canadian medical trainees cited their personal involvement and perceived ability to effect significant and identifiable positive change in both the school children and the community as reasons why they were more willing to practice in rural or under-served areas.

Prevalence of oral diseases/conditions in Uganda.

OBJECTIVES: The aim was to report the prevalence of oral diseases/conditions among a Ugandan population. METHODS: Subjects aged 12 (n=696) and 35-44 years (n=396) were chosen from randomly selected urban and peri-urban areas of Arua, Mbale, Kampala and Mbarara districts. They were clinically examined by 4 trained and calibrated dentists for oral diseases/conditions using criteria described by World Health Organisation. RESULTS: Dental caries (DMFT >or=1) was recorded in 40% and 62.5% of the children and adults, respectively. The overall mean DMFT score was 0.9 for children and 3.4 for adults. Caries was significantly more severe in females as compared to males in children (p<0.05), whereas in adults, there was no significant gender difference. Kampala had a significantly higher mean DMFT score compared to other districts in all age groups (p>0.05). Culculus deposits were generally, more prevalent in adults as compare to children except in Mbarara district. Gum bleeding was also significantly more prevalent among children as compared to adults (p<0.05). Significantly higher prevalence of gum bleeding in both children and adults was recorded in Arua district as compared to other areas (p<0.05). Each of the age groups had a prevalence of malocclusion of 61%. However, the severity of malocclusion varied between age groups and districts. The prevalence of dental fluorosis was 3% and 4% for children and adults, respectively. All subjects in Arua district were fluorosis-free. Tetracycline enamel staining was less than 1% in both age groups. Enamel attrition was more prevalent in adults as compared to children: 19% versus 1%. CONCLUSION: The prevalence of oral diseases/conditions was generally low among the study population. Caries experience was significantly higher in the Kampala (urban) district as compared to rural districts in all age groups; the D - component being the major contributor.

Neoplasms of the salivary glands: a descriptive retrospective study of 142 cases-Mulago Hospital Uganda.

OBJECTIVE: This study was aimed at establishing the prevalence, sex, age, and site distribution of salivary gland neoplasms as seen in the Department of Oral Surgery Mulago Hospital Uganda. DESIGN: Descriptive retrospective study. MATERIALS AND METHODS: Histopathological results from the Department of Oral Surgery were retrieved and analyzed for histological diagnosis, age, sex, and site. Records retrieved included those from January 1988 to December 2000. Student's t-test and z-test were used for data analysis. RESULTS: Of all neoplasms seen in the Department between 1988 and 2000, salivary gland tumors comprised 7.8% of which 77 (54.23%) were benign and 65 (45.77%) were malignant. Pleomorphic adenoma was the most prevalent over all. Among the malignant group, adenocarcinoma was the most prevalent of those where the palate was the most affected site. The age range was 1-80 years with the overall mean age being 33.83 +/- 18. 83. The mean age for the benign lesions was 26.74 +/- 16.0 and for the malignant lesions was 42.49 +/- 19.15. CONCLUSION: The findings were in agreement with most African studies but differed from studies from the other continents. Pleomorphic adenoma was the most prevalent salivary gland neoplasm with both males and females affected equally. More research is needed on specific salivary gland neoplasms in Uganda and preferentially on a regional basis geographically. However, if valid data on the diagnosis as well as age, site, and sex distribution are to be obtained, an improvement in the standardization of diagnosis and reporting of patient data will be necessary.