Opportunities and barriers to effective operation and maintenance of public toilets in informal settlements: perspectives from toilet operators in Kampala.

Although classified by the Joint Monitoring Programme (JMP) as unimproved sanitation facilities, public toilets still play a critical role in eliminating open defecation in informal settlements. We explored perspectives of toilet operators on opportunities and barriers to operation and maintenance (O&M) of public toilets in informal settlements. A cross-sectional study design was used. Up to 20 in-depth interviews were used to obtain data on the experiences of public toilet operators. Thematic content analysis was used. Ressults show that opportunities for improving O&M include; operation of public toilets is a source of livelihood; operators are knowledgeable on occupational risks, and the community is involvedin sanitation activities. Barriers to effective O&M include; high operation costs, failure to break even and a lack of investments in occupational health Therefore, there is need to recognise the significance of public toilets as a viable alternative to open defecation in areas where ownership of private sanitation facilities is difficult. Failure to observe the health and safety of toilet operators may further compromise O&M.

Factors associated with use of malaria control interventions by pregnant women in Buwunga subcounty, Bugiri District.

BACKGROUND: In Uganda, the Government has promoted the use of intermittent preventive treatment of malaria in pregnancy (IPTp) and insecticide-treated bed nets (ITNs) as malaria control strategies for pregnant women. However, their utilization among pregnant women is low. This study aimed at assessing factors associated with use of IPTp for malaria and ITNs by pregnant women in Buwunga sub-county, Bugiri District. METHODS: This was a cross-sectional study, conducted in Buwunga sub-county, Bugiri District, employing quantitative data collection tools. A total of 350 household members were randomly selected to participate in the study. Data were entered and analysed using Epi info version 3.5.1; bivariable and multivariable analysis was done to assess the factors associated with use of IPTp and ITNs among pregnant women. RESULTS: The level of uptake of IPTp1 (at least one dose) was 63.7 % while IPTp2 (at least two doses) was 42.0 %. More than half (58.6 %) of the mothers had slept under an ITN the night before the survey. Slightly more than half (51.9 %) of the mothers mentioned stock outs as the major reason for not accessing IPTp and ITNs. The main factors that were statistically significant for IPTp2 uptake were the knowledge of mothers on IPTp2 (AOR 2.48 95 % CI 1.53-4.02) and providing women with free clean water at the antenatal care (ANC) clinic (AOR 3.63 95 % CI 2.06-6.39). Factors that were significant for ITN utilization included education level of mothers (AOR 2.03 95 % CI 1.09-3.78), ease of access (AOR 2.74 95 % CI 1.65-4.52), and parity (AOR 1.71 95 % CI 1.01-1.29). CONCLUSION: The level of uptake of the two recommended doses of sulfadoxine-pyrimethamine (SP) tablets for malaria prevention (IPTp2) was low, slightly more than half of the mothers slept under an ITN the night before the survey. Appropriate measures to increase the level of uptake of IPTp2 and coverage of ITNs among pregnant women should be implemented, and these include providing health education about IPTp and ITNs, and ensuring that mothers are provided with free safe clean water at ANC clinic.

Lifejackets or just jackets? Seaworthiness of lifejackets sold at landing sites of Lake Albert, Uganda.

Objectives. Upon immersion in water, a cascade of human physiological responses is evoked, which may result in drowning death. Although lifejackets are over 80% effective in preventing drowning, many people in lakeside fishing communities in Uganda shy away from wearing them because of active distrust in the quality of the lifejackets on the local market. No study has determined the veracity of these claims. This study determined the seaworthiness of lifejackets sold at landing sites of Lake Albert, Uganda. Methods. Using a within-person repeated assessment design, we tested 22 new lifejacket samples obtained from landing sites of Lake Albert, Uganda. We conducted water entry, righting, floatation stability and minimum buoyancy performance tests. Results. All the lifejacket samples failed the minimum buoyancy functional requirements test; the average buoyancy was 80 N (SD 13). Only 4% of the lifejackets passed the righting test within 5 s. For floatation stability, 45% of the lifejackets sank earlier than 48 h of placement in water and also failed water entry tests by getting dislodged from the wearer. Conclusion. The lifejackets sold at the landing sites of Lake Albert do not meet minimum seaworthiness functional requirements. The government should regulate the quality of lifejackets on the local market.

Integrated Knowledge Translation for Non-Communicable Diseases: Stories from Sub-Saharan Africa.

Integrated Knowledge Translation (IKT) is a key strategy for contextualising, tailoring, and communicating research for policy and practice. In this viewpoint, we provide examples of how partners from five countries in sub-Saharan Africa used IKT to advance interventions for curbing non-communicable diseases in their contexts and how these strategies were magnified during the COVID-19 pandemic in some cases. The stories highlight the importance of deliberate and reinforced capacity building, authentic relationship enhancement, adaptable and user-informed stakeholder engagement, and agile multi-sectoral involvement.

Phenotypic Characterization and Antibiograms of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli Isolated at the Human-Animal-Environment Interface Using a One Health Approach Among Households in Wakiso District, Uganda.

Background: The occurrence of extended spectrum beta-lactamase (ESBL) producing bacteria such as Escherichia coli has increasingly become recognized beyond hospital settings. Resistance to other types of antibiotics limits treatment options while the existence of such bacteria among humans, animals, and the environment is suggestive of potential zoonotic and reverse-zoonotic transmission. This study aimed to establish the antibiotic susceptibility profiles of the ESBL-producing Escherichia coli (ESBL-EC) from human, animal, and environmental isolates obtained among farming households within Wakiso district using a One Health approach. Methods: A total of 100 ESBL-EC isolates from humans 35/100 (35%), animals 56/100 (56%), and the environment 9/100 (9%) were tested for susceptibility to 11 antibiotics. This was done using the Kirby-Bauer disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Data were analyzed in STATA ver. 16 and graphs were drawn in Microsoft excel ver. 10. Results: Most of the ESBL-EC isolates (98%) were resistant to more than two antibiotics. ESBL-EC isolates were most susceptible to meropenem (MEM) (88.0%), and imipenem (82.0%) followed by gentamicin (72%). ESBL-EC isolates from humans were most susceptible to meropenem (MEM) followed by imipenem (IPM)> gentamicin (CN)> ciprofloxacin (CIP). Animal samples were more susceptible to MEM, IPM, and CN but were highly resistant to cefotaxime (CTX)> cefepime (FEP)>other antibiotics. Multidrug resistance (MDR) was mostly reported among households keeping goats under intensive husbandry practices. Seven percent of the isolates exhibited carbapenem resistance while 22% showed aminoglycoside resistance. Similar resistance patterns among humans, animals, and environmental samples were also reported. Conclusion: Our study provides baseline information on non-hospital-based MDR caused by ESBL-EC using a One Health approach. ESBL-EC isolates were prevalent among apparently healthy community members, animals, and their environment. It is important to conduct more One Health approach studies to generate evidence on the drivers, resistance patterns, and transmission of ESBL-producing organisms at the human-animal-environmental interface.

Interventions to reduce pedestrian road traffic injuries: A systematic review of randomized controlled trials, cluster randomized controlled trials, interrupted time-series, and controlled before-after studies.

BACKGROUND: Road traffic injuries are among the top ten causes of death globally, with the highest burden in low and middle-income countries, where over a third of deaths occur among pedestrians and cyclists. Several interventions to mitigate the burden among pedestrians have been widely implemented, however, the effectiveness has not been systematically examined. OBJECTIVES: To assess the effectiveness of interventions to reduce road traffic crashes, injuries, hospitalizations and deaths among pedestrians. METHODS: We considered studies that evaluated interventions to reduce road traffic crashes, injuries, hospitalizations and/or deaths among pedestrians. We considered randomized controlled trials, interrupted time-series studies, and controlled before-after studies. We searched MEDLINE, EMBASE, Web of Science, WHO Global Health Index, Health Evidence, Transport Research International Documentation and ClinicalTrials.gov through 31 August 2020, and the reference lists of all included studies. Two reviewers independently screened titles and abstracts and full texts, extracted data and assessed the risk of bias. We summarized findings narratively with text and tables. RESULTS: A total of 69123 unique records were identified through the searches, with 26 of these meeting our eligibility criteria. All except two of these were conducted in high-income countries and most were from urban settings. The majority of studies observed either a clear effect favoring the intervention or an unclear effect potentially favoring the intervention and these included: changes to the road environment (19/27); changes to legislation and enforcement (12/12); and road user behavior/education combined with either changes to the road environment (3/3) or with legislation and enforcement (1/1). A small number of studies observed either a null effect or an effect favoring the control. CONCLUSIONS: Although the highest burden of road traffic injuries exists in LMICs, very few studies have examined the effectiveness of available interventions in these settings. Studies indicate that road environment, legislation and enforcement interventions alone produce positive effects on pedestrian safety. In combination with or with road user behavior/education interventions they are particularly effective in improving pedestrian safety.

Comparative analysis of competency coverage within accredited master's in health informatics programs in the East African region.

OBJECTIVE: As master of science in health informatics (MSc HI) programs emerge in developing countries, quality assurance of these programs is essential. This article describes a comprehensive comparative analysis of competencies covered by accredited MSc HI programs in the East African common labor and educational zone. MATERIALS AND METHODS: Two reviewers independently reviewed curricula from 7 of 8 accredited MSc HI university programs. The reviewers extracted covered competencies, coding these based on a template that contained 73 competencies derived from competencies recommended by the International Medical Informatics Association, plus additional unique competencies contained within the MSc HI programs. Descriptive statistics were used to summarize the structure and completion requirements of each MSc HI program. Jaccard similarity coefficient was used to compare similarities in competency coverage between universities. RESULTS: The total number of courses within the MSc HI degree programs ranged from 8 to 22, with 35 to 180 credit hours. Cohen's kappa for coding competencies was 0.738. The difference in competency coverage was statistically significant across the 7 institutions (P = .012), with covered competencies across institutions ranging from 32 (43.8%) to 49 (67.1%) of 73. Only 4 (19%) of 21 university pairs met a cutoff of over 70% similarity in shared competencies. DISCUSSION: Significant variations observed in competency coverage within MSc HI degree programs could limit mobility of student, faculty, and labor. CONCLUSIONS: Comparative analysis of MSc HI degree programs across 7 universities in East Africa revealed significant differences in the competencies that were covered.

State of pedestrian road safety in Uganda: a qualitative study of existing interventions.

BACKGROUND: Pedestrians in Uganda account for 40% of road traffic fatalities and 25% of serious injuries annually. We explored the current pedestrian road traffic injury interventions in Uganda to understand why pedestrian injuries and deaths continue despite the presence of interventions. METHODS: We conducted a qualitative study that involved a desk review of road safety policy, regulatory documents, and reports. We supplemented the document review with 14 key informant interviews and 4 focus group discussions with participants involved in road safety. Qualitative thematic content analysis was done using ATLAS. ti 7 software. RESULTS: Five thematic topics emerged. Specifically, Uganda had a Non-Motorized Transport Policy whose implementation revealed several gaps. The needs of pedestrians and contextual evidence were ignored in road systems. The key programmatic challenges in pedestrian road safety management included inadequate funding, lack of political support, and lack of stakeholder collaboration. There was no evidence of plans for monitoring and evaluation of the various pedestrian road safety interventions. CONCLUSION: The research revealed low prioritization of pedestrian needs in the design, implementation, and evaluation of pedestrian road safety interventions. Addressing Uganda's pedestrian needs requires concerted efforts to coordinate all road safety activities, political commitment, and budgetary support at all levels.

Coverage of IMIA-recommended Competencies by Masters in Health Informatics Degree Programs in East Africa.

OBJECTIVE: The International Medical Informatics Association (IMIA) has provided recommendations on Education in Biomedical and Health Informatics (BMHI) as guidance on competencies relevant to education of BMHI specialists. However, it remains unclear how well these competencies have been adopted to guide emerging degree programs in low- and middle-income countries (LMICs). We evaluated comprehensiveness of IMIA-recommended competency coverage by Masters in Health Informatics (MSc HI) programs in East Africa. MATERIALS AND METHODS: Two investigators independently reviewed curricula for seven accredited MSc HI university programs in the East Africa region to extract covered competencies using an instrument based on the IMIA education recommendations. Descriptive statistics were used to determine competency coverage by institution and across institutions and by IMIA-defined competency domains. Duplication of competency coverage in courses within each curriculum was also evaluated. Multivariable logistic regression was used to test whether coverage of IMIA-recommended competencies differed between institutions. RESULTS: Cohen's Kappa for coding competencies within courses was 0.738 (95% CI, 0.713-0.764). Coverage of the 40 recommended required IMIA competencies by institutional curricula ranged from 25 (62.5%) to 39 (97.5%) (p < 0.0001), with only 18 (45%) of these competencies covered by all seven institutions. No significant variations in competency coverage were observed between the domains of information sciences (83.7%), health sciences (71.4%), and core BMHI competencies (83.5%) (p = 0.13). On average, each competency was covered by 3.06 courses in each curriculum (range 0 - 14). Curricula also contained 25 additional competencies not part of the IMIA recommendations, 15 of which were found only within the curriculum of a single institution. DISCUSSION: There is significant variability in coverage of IMIA-recommended competencies across MSc HI curricula evaluated, with observed duplication of competency coverage within each curriculum. The additional competencies uncovered that were not part of the IMIA-recommendations were not universally shared across institutions. CONCLUSION: The IMIA education recommendations provide a relevant, comprehensive reference guide for developing and improving health informatics degree programs within LMIC settings. Variability in competency coverage needs to be addressed for institutions within similar educational and labor regions.