Development of a mentorship framework guide to promote the acquisition of interprofessional education and collaborative practice competencies during undergraduate training: a mini-Delphi cross-sectional study.

Background: The current global burden of disease which includes emerging and re-emerging diseases calls for interprofessional partnerships and team work to work collaboratively to solve community health problems. Inter-professional collaboration needs to start with training whereby learners are mentored in inter-professional teams and collaborative care. Many guidelines do exist in teaching and learning but faculty often do not have guidelines on how to mentor learners to acquire the needed inter-professional competencies. This study aimed at developing a mentorship guide for faculty to enable them to ably mentor learners in the acquisition of interprofessional competencies. Methods: It was a cross-sectional study involving both students and faculty mentors. Questionnaires were distributed to undergraduate students and the mentors at Makerere University College of Health Sciences and Busitema University Faculty of Health Sciences. Data from the participants was used alongside literature to develop the interprofessional education mentorship guide for faculty mentors. The guide was validated by a panel of experts. Results: From this study, students reported limited knowledge of the IPE core competencies and the faculty mentors corroborated this finding. Mentors did not directly give any feedback specifically targeting the IPE core competencies, though some of them unknowingly talked about some of the IPE competencies. The key challenges identified from students and faculty included limited training IPE and IPE core competencies and lack of guidelines for faculty mentors which they can follow to mentors students adequately across all the expected IPE competencies. Conclusion: There was limited mentorship in IPE competencies. Findings from this study alongside literature and expert validation, a framework guide for mentors in relation to IPE competencies has been proposed.

"No PBL is better than online PBL": Qualitative exploration regarding the perceived impact of online problem-based learning on nursing and medical students' learning during COVID-19 lockdown.

The COVID-19 pandemic and its restrictions increased the adoption of online learning even in low-income countries. The adoption of online teaching methods may have affected teaching and learning, particularly in settings where it was used for the first time. This study was conducted to explore the perceptions of medical and nursing students regarding the impact of online delivery of problem-based learning (PBL) on students learning and academic performance during COVID-19 imposed restrictions. Methods and materials: This was a qualitative study among fourth and fifth-year nursing and medical undergraduate students at Busitema University Faculty of Health Sciences. Four focused group discussions were conducted and the interviews focused on students' perceptions, experiences, and attitudes toward the PBL process conducted online and its likely impact on their learning. Braun and Clarke's thematic analysis was used for qualitative data analysis. Results: Four themes were identified that represented perceptions of online PBL on learning: transition to online learning; perceived benefits of online learning; limited learning and poor performance; and lost soft and practical skills. During the initial stages of introduction to online PBL learning, students transitioning to online had to adapt and familiarize themselves with online learning following the introduction of online learning. Students perceived that learning was less online compared to face-to-face sessions because of reduced learner engagement, concentration, motivation, peer-to-peer learning, and limited opportunities for practical sessions. Online learning was thought to increase students' workload in the form of a number of assessments which was thought to reduce learning. Online tutorials were perceived to reduce the acquisition of soft skills like confidence, communication, leadership, and practical or clinical skills. While learning was thought to be less during online teaching, it was noted to allow continued learning during the lockdown, to be flexible, enhance self-drive and opportunity for work, solve infrastructure problems, and protect them from COVID-19 infection. Conclusion: Generally, online learning enabled continuity and flexibility of learning. However, online PBL learning was perceived to be less engaging compared to traditional classroom-based PBL. Online PBL was seen to deter students from acquiring critical generic and clinical skills inherently found in traditional PBL. Innovative pedagogical measures should be adopted to avoid reduced learning noted in the online teaching methods to ensure the successful adoption of online teaching and learning in the post-COVID-19 era.

Sustained Retention, Viral Load Suppression and their Determinants Among Clients on HAART Enrolled Under Differentiated Service Delivery Models in Eastern Uganda.

Background: Although Uganda rolled out Differentiated Service Delivery(DSD) models in June 2017 to improve retention and viral load suppression rates among clients on Highly Active Antiretroviral Therapy (HAART), these have remained low relative to the Joint United Nations Programme on HIV/AIDS(UNAIDs) targets of achieving 95% population with HIV tested, 95% of tested positive clients for HIV to be on Highly active Antiretroviral therapy and 95% of clients On Antiretroviral therapy be suppressing by 2030(95-95-95 UNAIDS targets). The purpose of this study was to determine sustained retention, viral load suppression and their determinants among clients on HAART enrolled under different Differentiated service delivery models in Katakwi district in Eastern Uganda. Methods: A retrospective cohort study of clients enrolled on HAART in the different approaches of DSD who were active by 2017 and followed up to 2020 was done. The primary outcomes included sustained retention, viral load suppression and their determinants among clients HAART in different DSD approaches. Eight health facilities providing HAART services were purposively sampled and 771 clients on HAART were sampled out by simple random selection from a total population of 4742 clients on HAART in Katakwi district. We analysed retention, viral load suppression rates, and their determinants by logistic regression method using STATA. Results: A total of 771 participants were sampled of whom 42.7% were male and 57.3% were female, with the mean age being 40 years. Retention rates at 95% CI of participants were 99.35% at 12 months, 94.03 at 24 months, 89.88% at 36 months and 84.57% at 48 months. The viral load suppression rates were 57.3% at 12 months, 70.3% at 24 months, 70.3% at 36 months and 69% at 48 months. Retention was higher in the community based DSD model as compared to the facility-based model. Viral load suppression was higher in the community based DSD models in which Community Drug Distribution Points had the highest achievement (92%) followed by Community Client-Led ART Distribution (79%) compared to the facility based DSD models in which Facility Based Individual Management performance (34.3%) was far below the set standard of 95%, followed by Facility Based Groups (65%) with Fast Track Drug Refill having relatively better performance (80.9%). Being 40-59 years, receiving care from the general hospital, being married, having good current adherence, being on the first line of the current regime and being a female are other predictors of viral load suppression, whereas being 40-59 years of age, having good current adherence, being on the current first-line regime and having no co-morbidities were predictors of good retention. Conclusions: generally, facility and community based DSD models have demonstrated improved retention and viral load suppression. However, community-based models have shown to be more effective than facility-based models through mitigation of barriers to effective HIV/AIDS care of clients on HAART. Viral load suppression remained below the UNAIDs target of 95% by 2030, albeit it improved over time.

Attitudes and perceptions of undergraduate nursing students towards the nursing profession.

BACKGROUND: Nursing students either possess positive or negative attitudes and perceptions about the nursing profession. Their attitudes towards the profession depict the quality of care they will offer to patients upon qualification. This study aimed to determine the attitudes and perceptions of undergraduate nursing students towards their profession. METHODS: This equal-status mixed methods study involved a census sample of 165 nursing students from year one to year four in two public universities in Uganda. Attitude Scale for Nursing Profession was used to collect quantitative data in the period between 20/11/2021 and 22/01/2022. Focus group discussions were held to collect qualitative data about the perceptions. RESULTS: Majority of the students (81.8%) had positive attitudes towards the nursing profession. There was a significant difference in attitudes based on year of study and entry scheme (R2 = 0.12, F = 2.21, p = 0.01). Nursing was perceived as a poorly remunerated, unpopular profession with bias towards recruitment of lower cadres. CONCLUSION: The results of this study showed that the attitudes of undergraduate nursing students towards the nursing profession were positive but their perceptions about the nursing profession were negative. An interventional study is recommended to facilitate a more positive change among nursing students.

Lived experiences of caregivers of persons with epilepsy attending an epilepsy clinic at a tertiary hospital, eastern Uganda: A phenomenological approach.

INTRODUCTION: Epilepsy has been found to affect caregivers' quality of life, lifestyle, psychological health, social well-being, and working time. Caregivers in Uganda as in the rest of the world are important in assisting a person with epilepsy in complying with medical directions and are actively involved in communicating with healthcare professionals. Little is known about the lived experiences of caregivers of persons afflicted with epilepsy in Uganda. The purpose of this study was to determine the lived experiences of caregivers of persons with epilepsy attending the epilepsy clinic at Mbale regional referral hospital, eastern Uganda. METHODS AND MATERIALS: The caregivers' lived experiences were elicited directly from them and their health workers who work with them in the care of the patients. Forty participants which consisted of 30 caregivers and 10 key informant health workers were selected for the study through purposive sampling. Face-to-face in-depth interviews with an unstructured interview guide were conducted to gather participants' information. The principal investigator conceptualized the interview guide, the guide was then reviewed by co-investigators, and revised and approved as the final data collection instrument after an extensive and comprehensive literature review. The interview guide comprised two sections; the first section comprised the questions that elicited the participants' social-demographic information. The second section comprised questions that explored caregivers' experiences of persons afflicted with epilepsy. Notations were taken and a digital recorder was used purposely for audio recordings. All interviews lasted for an hour and were audio-recorded with the participant's consent. An inductive thematic analysis was employed and adopted to identify the patterns emerging from the texts. RESULTS: The caregivers majorly perceived epilepsy as a burden. Four main themes were revealed from the analysis and these are: psychological burdens which included, worries about the future of the patient, being looked down upon; social burdens which entailed, affected public relations, feelings of stigma; an economic burden which included interference with the source of income, affected productivity at work; and physical burdens which included, Feelings of uneasiness and disrupted sleep among others. CONCLUSION: The caregivers majorly perceived epilepsy as a serious burden. This burden can be psychological, social, economic, and physical. Therefore, services and plans targeting patients with epilepsy need to consider the burden that caregivers encounter to comprehensively manage epilepsy.

SHARP/NEEDLESTICK INJURIES AMONG CLINICAL STUDENTS AT A TERTIARY HOSPITAL IN EASTERN UGANDA.

Background: Clinical students, like health workers, are at risk of sharp/needle stick injuries and potential percutaneous exposure to blood and body fluids. They acquire infections like Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) through injuries. This study determined the prevalence and factors associated with sharp injuries among clinical students at Mbale Regional Referral Hospital. Methods: Across sectional study was carried out at Mbale Regional Referral Hospital, a teaching hospital located along Pallisa road, Mbale City, Eastern Uganda. Ethical approval was obtained, Printed and soft copy questionnaires eliciting demographics, injury occurrence and associated factors were randomly and conveniently distributed respectively to 322 clinical students. Data was entered in Microsoft excel, cleaned and exported to STATA version 14 for analysis. Results: One hundred sixty (55.2%) clinical students had sustained a sharp injury in their clinical practice with a self-reported prevalence of 46.6% in the last year. The majority of the students 93(68.9%), sustained multiple sharp injuries. The common cause and site of injury were solid needles 72(45%) and finger (83.1%). Most students, 197(67.9%) reported ward procedures not being supervised and 124(42%) students worked on 15 and above patients daily. Final year clinical students were more likely to sustain sharp injuries than semi-finalists (P=0.000, OR 3.195% CI 1.7-5.5). Students who worked on ≥15 patients were more likely to sustain a sharp injury than those who attended to < 15 patients daily (P=0.000, OR 6.3 95% CI 3.7-10.8%). Students' knowledge about sharp/infection control was limited. Conclusion: This study showed a high prevalence of needle stick injuries among clinical students. The associated factors were; the year of study, having not learned about infection control, the number of patients attended to daily. Students should attend to a manageable number of patients, carry out procedures not rushing while supervised. It is important to create awareness and train students on infection control before and during their deployment in clinical areas as their health and the future of the health sector depend on them.

Psycho-social challenges faced by caretakers of children and adolescents aged 0-19 years with sickle cell disease admitted in a tertiary hospital in Eastern Uganda.

BACKGROUND: Families of children and adolescents living with sickle cell disease face several challenges ranging from psycho-social to social-economic challenges. This study aimed to explore psycho-social challenges experienced by caretakers of children and adolescents aged 0-19 years with SCD and the various coping mechanisms. METHODS: A mixed-methods cross-sectional study was carried out among caregivers of children with SCD who were admitted to the pediatric wards of the Mbale Regional Referral Hospital from September 2019 to November 2019. A total of 333 participants were interviewed using a pretested questionnaire and 11 in-depth interviews were conducted. RESULTS: Most participants 285(85.59%) reported that they experienced psychological challenges and almost all the participants in this study 297(89.19%) experienced social challenges during the care of their patients. Only 36(10.81%) reported not experiencing any social challenges. Almost all the participants reported coping with the situation in various ways of which, 296(88.89%) used acceptance, 9(2.7%) still lived in denial, while 9(2.7%) used talking with others and getting counseled to reduce the intensity of the feelings experienced. Three themes were generated from the in-depth interviews; knowledge of the child's health condition; common symptoms and care, the experience of psycho-social challenges, and coping strategies. CONCLUSION: Sickle cell disease has affected two sets of people; the people living with the disease and those who are caring for their loved ones. Being conscious of this will help health practitioners to be more empathetic to patients and caregivers when treating people living with sickle cell disease. The biggest proportion of caretakers of children and adolescents 0-19 years experienced psycho-social challenges. The main coping strategy used by the caretakers was acceptance.

Undergraduate research- a tale of three African institutions.

Background: The inclusion of research in undergraduate medical curricula benefits students as well as the scientific community. Multiple studies report the presence of one or more barriers to research training in these curricula. Objectives: This paper presents and compares three studies done regarding the teaching of research in undergraduate medical curricula in South Africa, Sudan and Uganda. Methods: Two cross-sectional study designs (South Africa and Sudan) and one interventional study design (Uganda) were conducted. Both cross-sectional studies used mixed methods while the Ugandan study used a quantitative method. A total of 41 faculty members and 554 students participated. The studies used a combination of surveys, focus group discussions, key informant interviews and document analysis. Results: Participants from all three studies valued research and considered it useful and relevant to their studies. The findings from the South African and Sudanese studies align with the 'Four I's' framework that summarise the barriers to research training as lack of initiative, impulse, incentive and idols. The Ugandan study demonstrated improved self-reported knowledge and attitude (specifically anxiety) among participants after completion of a short course on research.

COVID-19 Vaccination Uptake and Self-Reported Side Effects among Healthcare Workers in Mbale City Eastern Uganda

BackgroundFear of anticipated side effects has hindered the COVID-19 vaccination program globally. We report the uptake and the self-reported side effects (SEs) of the COVID-19 vaccine among Healthcare workers (HCWs) in Mbale City Eastern Uganda. MethodsA cross-sectional survey of HCWs at seven different level health facilities was conducted from 6th September to 7th October 2021 using a structured self-administered questionnaire. ResultsCOVID-19 vaccine had been received by 119 (69%) participants of which 79 (66%) received the two recommended doses of the AstraZeneca vaccine. Getting vaccinated was associated with working in a lower health facility (aOR= 14.1, 95% CI: 4.9 - 39.6, P=0.000), perceived minor risk of contracting COVID-19 (aOR= 12.3, 95% CI: 1.0 - 44.6, p=0.047), and agreeing that COVID-19 vaccine is protective (aOR= 16.7, 95% CI: 5.6 - 50.4, p=0.000). 97 (82%) of participants experienced side effects to at least one dose of which most were mild on both the first (n=362, 51%) and second dose (n=135, 69%). The most frequently reported side effects on the first and second dose were fever (79% and 20%), injection site pain (71% and 25%), and Fatigue (69% and 20%) respectively. ConclusionsThe majority of the HCWs in Mbale City had received at least one dose of the COVID-19 vaccine and experienced a side effect. The side effects were mostly mild on either dose thus the vaccines are generally safe.

Anxiety and Coping Strategies during the Covid-19 Pandemic among Students at a Multi- Campus University in Uganda.

Background: Uganda has had the longest COVID-19-induced closures of schools world over of over 20 months, according to a recent UNICEF report, which has greatly affected learning and mental health of University students. This study assessed levels of anxiety, challenges and coping strategies of students at a university in Uganda during the COVID-19 pandemic lock down. Methods: We conducted an online, descriptive, cross-sectional study between 26th June and 26th July 2021 using mixed quantitative and qualitative methods among students of Busitema University in Eastern Uganda. The survey assessed anxiety levels of students using General Anxiety Disorder 7 (GAD-7) scale, and its associations using the Chi-Square or Fischer's exact test and multivariate logistic regression. We also explored the challenges and coping strategies employed by students through in-depth interviews. Results: A total of 338 students participated, 213 (63%) were male with median age of 23 years (21-25), majority from Faculty of health sciences (n = 153, 45%). Overall, 179 (53%) of the students had anxiety which was mostly mild anxiety (n = 127, 38%). Students concerned about inadequate internet facilities to support online learning were twice more likely to have anxiety (aOR 2.0, 95% CI 1.1-3.7; p = 0.021). Among those with anxiety, avoidance coping strategies had higher scores with a median of 8 (3-12) compared to other strategies (p < 0.001). In-depth interviews revealed challenges with online learning, academic progress, and changes to daily routine and fear of contracting COVID-19 and getting vaccinated. Conclusion: The largest number of students had anxiety especially those from faculty of health sciences and engineering of which most used avoidance strategies to cope up with the anxiety. This highlights areas where the university authorities should gear effort to design appropriate strategies to maintain mental health of students even after the pandemic.

Bacterial colonization, species diversity and antimicrobial susceptibility patterns of indwelling urinary catheters from postpartum mothers attending a Tertiary Hospital in Eastern Uganda.

BACKGROUND: Postpartum urinary Catheter-Related Infections (CRIs) are a significant cause of maternal sepsis. Several studies done have reported the presence of mixed populations of bacteria with a significant increase in Extended-Spectrum Beta-Lactamase (ESBL) Enterobacteriaceae spps, Methicillin-Resistant Staphylococcus aureus (MRSA), Multi-Drug Resistant (MDR) bacteria in urine and blood cultures of catheterized patients despite the use of prophylactic antibiotics. This study aimed at determining the bacterial species diversity and susceptibility patterns of indwelling urinary catheters from postpartum mothers attending Mbale Regional Referral Hospital (MRRH). METHODS: A cross-sectional study employing quantitative and qualitative was carried out in MRRH among postpartum mothers with urinary catheters and their care-takers. The purposive non-random sampling strategy was used to collect data using an interviewer-administered questionnaire for the quantitative data collection and in-depth interviews for qualitative data collection. All the data collection tools used were developed, pretested and validated. At the point of de-catheterization, Catheter tips from enrolled participants were cut about 2-3cm below the balloon aseptically into test-tube containing peptone water, sonication technique employed, and incubation done 24hours then cultured to ensure phenotypic identification. An antibiotic sensitivity test was performed using the disc diffusion method following Clinical and Laboratory Standards Institute (CLSI) guidelines. Quantitative data collected was entered in Microsoft Excel and then exported to STATA14 for statistical analysis. Thematic analysis was used to analyse and organise qualitative data by an inductive coding method using Nvivo 12 software. RESULTS: In this study, 208 postpartum mothers participated, the majority of whom were caesarean section mothers of age range 20-24 years and 17 care-takers with a median age of 32 years. The prevalence of catheter tips bacterial colonisation was 98% despite 88.5% of the participants being on broad-spectrum antibiotics. The average duration of catheterisation was 2 days. All bacteria isolates were potential uro-pathogens with a mean occurrence of 2 bacteria species in each urinary catheter tip. The rates of MDR to commonly used antibiotics were high. The urinary catheter size of greater than F14 and duration of catheterization greater than 2 days were significantly associated with the number of bacterial species isolated from each sample. The maintenance care and knowledge of care-urinary catheter care among the care-takers was found sub-optimal. CONCLUSION: There was a high prevalence of catheter colonisation with bacterial spps diversity averaging 2 spps per sample despite use of broad spectrum antibiotics. The MDR rates were high, which calls for routine culture and sensitivity. Health workers practicing obstetric medicine need to pay attention to catheter sizes during catheterisation and its duration. Health education should be part of antenatal and postnatal care education.

KANGAROO MOTHER CARE: A QUALITATIVE STUDY ON THE PRACTICE AND EXPERIENCES OF MOTHERS OF PRETERM NEONATES IN A TERTIARY TEACHING HOSPITAL IN EASTERN UGANDA.

Introduction: Globally, neonatal deaths continues to be a challenge especially to to attainment of sustainable development goal 3. About 4 million neonatal deaths per year, with 99% of the deaths occurring in low and middle resource countries, 75% of these occurring in the first week of life. Prematurity remains an indirect leading cause of mortality and morbidity. Uganda's progress on the improvement of perinatal morbidity and mortality has largely stagnated at 27 deaths per 1,000 live births from the year 2006. One of the cost-effective readily available interventions that would curtail perinatal mortality is kangaroo mother care(KMC)- a low tech four decades old intervention. However challenges about its implementation persist on in Uganda despite intensified implementation and roll-out startegies in 2010. This study, the first of its kind to the best of our knowledge in eastern Uganda sought to find the facilitators and barriers of KMC. Materials and methods: This was a qualitative study using in-depth interviews(IDI) carried out at a tertiary university teaching hospital. Twenty IDIs were carried out among mothers/caretakers using the phenomena theory. After each IDI, each transcript was analyzed by two researchers working independently using NVIVO software version 11 plus (QSR International, Burlington, Massachusetts) and themes and subthemes developed. Results: Majority of mothers/caretakers, were adolescents and young adults and primiparous at 55%. The major facilitators to KMC were supportive staff that facilitated positive attitude, ability to substitute provider and family support.The major barriers were lack of family support, lack of male involvement, maternal stress and poor health and multiple gender roles, infrastructural challenges, and misconceptions associated with preterm births such as early sexual intercourse and lack of herbal medicine use. Conclusion: More facility leadership involvement and engagement of mothers during antenatal, community and promotion of male involvement in sexual and reproductive health matters will improve uptake of KMC. This can be spearheadded by sexual and reproductive health, and neonatal and child health care service providers.

Prevalence, Indications, and Community Perceptions of Caesarean Section Delivery in Ngora District, Eastern Uganda: Mixed Method Study.

BACKGROUND: Uganda has a high maternal mortality ratio (MMR) of 336/100,000 live births. Caesarean section is fundamental in achieving equity and equality in emergency obstetric care services. Despite it being a lifesaving intervention, it is associated with risks. There has been a surge in caesarean section rates in some areas, yet others remain underserved. Studies have shown that rates exceeding 15% do not improve maternal and neonatal morbidity and mortality. Our study aimed at determining the prevalence, indications, and community perceptions of caesarean section delivery in Eastern Uganda. METHODS AND MATERIALS: It was both health facility and commuity based cross-sectional descriptive study in Ngora district, Eastern Uganda. Mixed methods of data collection were employed in which quantitative data were collected by retrospectively reviewing all charts of all the mothers that had delivered at the two comprehensive emergency obstetric care service facilities between April 2018 and March 2019. Qualitative data were collected by focus group discussions till point of saturation. Data were entered into EpiData (version 3.1) and analyzed using SPSS software (version 24). Qualitative data analysis was done by transcribing and translating into English verbatim and then analyzed into themes and subthemes with the help of NVIVO 12. RESULTS: Of the total 2573 deliveries, 14% (357/2573) were by CS. The major single indications were obstructed labour 17.9%, fetal distress 15.3%, big baby 11.6%, and cephalopelvic disproportion (CPD) 11%. Although appreciated as lifesaving for young mothers, those with diseases and recurrent intrauterine fetal demise, others considered CS a curse, marriage-breaker, misfortune, money-maker and a sign of incompetent health workers, and being for the lazy women and the rich civil servants. The rise was also attributed to intramuscular injections and contraceptive use. Overall, vaginal delivery was the preferred route. CONCLUSION: Several misconceptions that could hinder access to CS were found which calls for more counseling and male involvement. Although facility based, the rate is higher than the desired 5-15%. It is higher than the projected increase of 36% by 2021. It highlights the need for male involvement during counseling and consent for CS and concerted efforts to demystify community misconceptions about women that undergo CS. These misconceptions may be a hindrance to access to CS.

Malaria preventive practices and delivery outcomes: A cross-sectional study of parturient women in a tertiary hospital in Eastern Uganda.

BACKGROUND: Uganda ranks third in the number of deaths attributable to malaria and has some of the highest recorded malaria transmission rates in the general population. Malaria in Pregnancy is associated with detrimental effects for the mother and unborn baby and these effects seem to have long term effects and consequences on the life of the baby. Despite the preventive measures put in place by the World Health Organization in antenatal care, the burden of malaria in pregnancy is still high. We determined the use of malaria preventive strategies during pregnancy and the presence of plasmodium infection, anemia, and low birth weight babies at delivery among parturient women at Mbale regional referral hospital in eastern Uganda. METHODS: A cross-sectional study was conducted among 210 women delivering at MRRH between July 2017 and January 2018. Information on demographics, antenatal care, and prevention practices was collected using an interviewer-administered questionnaire. Maternal venous blood and cord blood samples were screened for Plasmodium infection by both microscopy of Giemsa-stained blood films and Plasmodium falciparum rapid diagnostic test (pf. HPR2 mRDT). Polymerase Chain Reaction (PCR) was done on cord blood. The presence of anemia was determined by the use of an automated hemoglobin analyzer. Data were analyzed using descriptive and analytical statistics. RESULTS: Of the 210 women, 3 (1.4%) and 19(9.1%) tested positive for malaria by using Giemsa stained blood smear microscopy and malaria rapid diagnosticMRDT tests respectively. PCR detected 4(%) of Plasmodium in cord blood. Twenty-nine percent of the women had anaemia and 11 (5.2%) had low birth weight babies. Only 23.3% of the women received at least three doses of IPTp-SP and 57.9% reported sleeping under an Insecticide Treated Net the night before the survey. The women who reported sleeping under a mosquito net the previous night (OR 0.67, 95% CI: 0.24-1.86) and those who reported taking fansidar as a directly observed therapy (OR 0.31, 95% CI: 0.04-2.39) appeared to have few chances of getting plasmodium infection though the findings were not statistically significant. CONCLUSION: The effective use of malaria preventive strategies (IPT-SP and Insecticide Treated Nets) was generally low. Most of the women took less than three doses of SP and there was no strict adherence to the recommended directly observed therapy. The prevalence of Plasmodium infection during pregnancy was low though maternal anaemia and low birth weight were relatively high.

Asymptomatic bacteriuria among pregnant women attending antenatal care at Mbale Hospital, Eastern Uganda.

BACKGROUND: Asymptomatic bacteriuria in pregnancy (ASBP) is associated with adverse pregnancy outcomes such as pyelonephritis, preterm or low birth weight delivery if untreated. The aim of this study was to determine the prevalence of asymptomatic bacteriuria, the isolated bacterial agents, and their antibiotic sensitivity patterns in pregnant women attending antenatal care at Mbale Hospital. METHODS: This was a cross sectional study in which 587 pregnant women with no symptoms and signs of urinary tract infection were recruited from January to March 2019. Mid-stream clean catch urine samples were collected from the women using sterile containers. The urine samples were cultured using standard laboratory methods. The bacterial colonies were identified and antibiotic sensitivity was done using disc diffusion method. Chi squared tests and logistic regression were done to identify factors associated with asymptomatic bacteriuria. A p value < 0.05 was considered statistically significant. RESULTS: Out of the 587 pregnant women, 22 (3.75%) tested positive for asymptomatic bacteriuria. Women aged 20-24 years were less likely to have ASBP when compared to women aged less than 20 years (AOR = 0.14, 95%CI 0.02-0.95, P = 0.004). The most common isolates in descending order were E. coli (n = 13, 46.4%) and S.aureus (n = 9, 32.1%). Among the gram negative isolates, the highest sensitivity was to gentamycin (82.4%) and imipenem (82.4%). The gram positive isolates were sensitive to gentamycin (90.9%) followed by imipenem (81.8%). All the isolates were resistant to sulphamethoxazole with trimethoprim (100%). Multidrug resistance was 82.4% among gram negative isolates and 72.4% among the gram positive isolates. CONCLUSION: There was high resistance to the most commonly used antibiotics. There is need to do urine culture and sensitivity from women with ASBP so as to reduce the associated complications.

Baseline Assessment of Risk Factors of Presumptive Tuberculosis among under Five Children Living with an Index Client under Treatment in Mbale District, Eastern Uganda.

BACKGROUND AND AIMS: Children in contact with adults having pulmonary Tuberculosis (TB) are vulnerable to TB infection and hence contact tracing and screening is important for early detection of infection. However, there are few contacts traced and the prevalence and risk factors for transmission are not well studied. The objective of this study was to determine the prevalence of infection and risk factors associated with TB transmission among under five children in household contact with adult pulmonary TB patients. MATERIALS AND METHODS: A cross sectional study was carried out in three health facilities with a high TB burden in Mbale District, Eastern Uganda involving all under five household contacts of adults with pulmonary tuberculosis recorded in the TB register from October 2018 to March 2019 and still on treatment. Structured questionnaires were administered to the index clients to obtain their demographic and clinical data about TB, HIV as well as information on the children. Children were screened using the intensive case finding forms to identify presumptive cases. RESULTS: The total number of index TB Clients line listed were 70. Number of clients traced was 38, 21 (%) of whom had children under five years and a total of 33 children were identified. The number of presumptive cases was 9/33 (27.27%). 77.8% of the presumptive cases were living in poorly ventilated houses. CONCLUSION: The study identified children with presumptive TB and various risk factors for TB transmission. Intensive contact tracing can therefore help reduce TB transmission within the communities. It is recommended to undertake studies aiming at improving contact tracing and strategies to eliminate the risk factors to TB transmission.

Towards universal health coverage: Data for determinants of immunization coverage of Pneumococcal and Rota virus vaccines among under five children in Busolwe Town Council, Butaleja District, Eastern Uganda.

The data described stipulates the factors influencing the immunization coverage of Pneumococcal and Rota Virus Vaccines among under five children (U5C) in Butaleja district in Eastern Uganda. The data was obtained in three major sections of demographic characteristics, knowledge, and attitude and perceptions of care takers of U5C on immunization. Both qualitative and quantitative types of data obtained from Primary and Secondary data sources are presented. The Primary sources included administration of questionnaires to the caretakers of U5C in communities surrounding different health centers in Butaleja district. The secondary source of data was majorly the Health Management Information Systems (HMIS) records of Busolwe District Hospital. The data includes raw data from individual participants in form of Google forms portable document format, the consolidated raw data from all the participants in Microsoft excel format, as well as raw data from secondary HMIS record on immunization coverage in form of Microsoft excel format. The data provides a general outlook on the state of Butaleja district in terms immunization coverage of Pneumococcal and Rota Virus Vaccines. The data can be useful in taking action to decrease the burden of vaccine preventable diseases in Butaleja and elsewhere in similar settings. The data described is freely available in the Mendeley Data repository at the following site: https://doi.org/10.17632/zr2w886dg2.1 (Nabwana et al., 2019).

Community- based Active Tuberculosis Case Finding in Pastoralist Communities of North-Eastern Uganda.

BACKGROUND: Given the global urgency to improve tuberculosis (TB) case detection, a renewed interest in active case finding (ACF) has risen. Missed TB cases pose a serious threat as they continue to fuel TB transmission in the community. We aimed to assess the feasibility of community based ACF for TB among people living in a pastoralist community in Uganda and determine its impact on case detection and treatment uptake. METHODS: Between April and May 2019, four third year medical and nursing students placed at Moroto Regional Referral for community orientation worked together with community health workers to conduct a door-to-door survey for TB in pastoralist communities of Nadunget Sub County, Moroto district. The community health workers and the Medical/Nursing students performed symptom screening, collected sputum and facilitated specimen transport to the laboratory. Gene Xpert MTB/RIF assay was performed at the regional referral Hospital for all sputum samples. The community health workers were tasked to follow up on all those clients whose samples turned out to be positive so that they could start treatment as soon as possible. All presumptive cases with negative sputum results were referred to the TB clinic for further evaluation. RESULTS: In one month, we screened 385 individuals and identified 143 aged above 15 years with symptoms suggestive of TB. Among the presumptive cases, 132 (92%) reported a cough of more than two weeks and we were able to obtain sputum samples from 84(58.7%) participants. We diagnosed 11, including 8 bacteriologically confirmed TB cases using Gene Xpert and there was no multidrug resistant case identified. The median time from sputum collection to notification of the positive result was 3 days. All the positive cases were followed up and initiated on treatment. CONCLUSION: The findings from our study suggest that in a pastoralist community, ACF for TB using a sensitive symptom screen followed by Gene Xpert contributed to improved case detection of TB, shortening the turnaround time hence timely initiation of patients on TB treatment.

Socio-demographic Determinants of Vaccine Coverage for Pneumococcus and Rotavirus among under Five Children in Busolwe Town Council, Butaleja District, Eastern Uganda: A Cross Sectional Study.

BACKGROUND AND AIMS: There is a high burden of vaccine-preventable diseases in the children under five years of age, particularly pneumonia diarrhea and which is greatly affected by low immunization coverage despite the existing efforts and policies. This study was carried out in Butaleja district and was aimed at establishing the socio-demographic determinants of vaccine coverage for pneumococcus and rotavirus among under five children (U5C) in the district. STUDY DESIGN: This was a mixed methods cross-sectional study. PLACE AND DURATION OF STUDY: Busolwe Town Council, Butaleja District, Eastern Uganda. METHODOLOGY: Structured researcher administered questionnaires were administered to 434 caregivers of U5C in different parts of Butaleja district. In-depth interviews with key informants and focused group discussions with Village Health Teams and community members were conducted. Review of Health Management Information Systems records was done. STATA 15 was used to analyze the data. RESULTS: The study found that there is a declining trend in completion of the doses of Pneumococcal vaccine (PCV) and Rotavirus vaccine. For example, in quarter 1 of 2019, out of the 312 children who started immunization, only 2 completed Rota virus immunization and only 117 completed PCV vaccinations a trend that has been observed since 2016. The factors that showed a significant association with the the fact that they gave their child at least one dose of the vaccine were having been sensitized on the current immunisation schedule(P-value = <0.001), misunderstanding that vaccine is harmful for child (P-value = 0.007), willingness to take children to vaccination (P-value = <0.001), and social factors such as family (P-value = <0.030). Gender also played a key determinant role where the children's fathers lacked knowledge on significance of immunization and thus discouraged the mothers from taking the children for immunization. Inadequate funding was also highlighted from the Focus Group Discussions. CONCLUSION: Vaccine coverage for pneumococcus and rotavirus is still low in Butaleja district mainly due to the attitudes and perceptions of caregivers as well as the knowledge gap. There is need for extensive sensitization of all community members to enable them understand the significance of immunization. It would further be important to increase the funding of the immunization programme to intensify and ensure effectual outreaches as well as the establishment and enforcement of a policy for immunization compliance.