Preparedness of health care systems for Ebola outbreak response in Kasese and Rubirizi districts, Western Uganda.

BACKGROUND: The level of preparedness of the health care workers, the health facility and the entire health system determines the magnitude of the impact of an Ebola Virus Disease (EVD) outbreak as demonstrated by the West African Ebola outbreak. The objective of the study was to assess preparedness of the health care facilities and identify appropriate preparedness measures for Ebola outbreak response in Kasese and Rubirizi districts in western Uganda. METHODS: A cross sectional descriptive study was conducted by interviewing 189 health care workers using a structured questionnaire and visits to 22 health facilities to determine the level of health care system preparedness to EVD outbreak. District level infrastructure capabilities, existence of health facility logistics and supplies, and health care workers' knowledge of EVD was assessed. EVD Preparedness was assessed on infrastructure and logistical capabilities and the level of knowledge of an individual health work about the etiology, control and prevention of EVD. RESULTS: Twelve out of the 22 of the health facilities, especially health center III's and IV's, did not have a line budget to respond to EVD when there was a threat of EVD in a nearby country. The majority (n = 13) of the facilities did not have the following: case definition books, rapid response teams and/or committees, burial teams, and simulation drills. There were no personal protective equipment that could be used within 8 h in case of an EVD outbreak in fourteen of the 22 health facilities. All facilities did not have Viral Hemorrhagic Fever (VHF) incident management centers, isolation units, guidelines for burial, and one-meter distance between a health care worker and a patient during triage. Overall, 54% (n = 102) of health care workers (HCWs) did not know the incubation period of EVD. HCWs who had tertiary education (aOR = 5.79; CI = 1.79-18.70; p = 0.003), and were Christian (aOR = 10.47; CI = 1.94-56.4; p = 0.006) were more likely to know about the biology, incubation period, causes and prevention of EVD. CONCLUSIONS: Feedback on the level of preparedness for the rural districts helps inform strategies for building capacity of these health centers in terms of infrastructure, logistics and improving knowledge of health care workers.

Prevalence and predictors of work-related musculoskeletal disorders among workers of a gold mine in south Kivu, Democratic Republic of Congo.

BACKGROUND: Work-related musculoskeletal disorders (WRMSDs) are a major constraint to worker performance and health. However, research on their prevalence and associated factors among workers at gold mines in the Democratic Republic of Congo (DRC) is insufficient. The present study aimed to determine the prevalence and predictors of WRMSDs among workers of a Gold Mine in South Kivu, DRC. METHODS: Cross sectional data on prevalence of WRMSDs and risk factors was collected using a modified Nordic questionnaire and upper limb Core QX checklist from 196 workers of a gold mine. WRMSDs were defined as pain or injury(ies) or discomfort, numbness or limitation of movement in the musculoskeletal system at any time in the past 12 months which lasted at least 24 h. These had to be either induced or aggravated by work and circumstances of its performance. A generalised linear model of the Poison family with link log and robust error variances was used to generate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the factors associated with WRMSDs. The effect of individual, ergonomic and psychosocial factors on WRMSDs were investigated while controlling for known confounders. RESULTS: Most workers were males 187 (95.4%) and their age ranged between 23 and 60 years with mean of 36.3 years. Of the 196 workers, 49 (25.0%) reported having at least one WRMSD during the previous 12 months. WRMSDs with highest occurrence rate were the lower back pain (14.8%), followed by thighs/hip pain (9.2%) and shoulder pain (8.2%). Prolonged heavy lifting/shovelling shovelling (PR = 1.69, 95% CI [1.32, 3.24] and longer work shifts (> 9 h) (PR = 3.56, 95% CI [1.76, 16.58]) were predictive for WRMSDs while jobs with low demands were protective against WRMSDs (PR = 0.18, 95% CI [0.08, 0.44]). CONCLUSION: The prevalence of WRMSDs is high and associated with prolonged heavy lifting/shovelling, longer work shifts and job demands. We recommend lowering workload and job demands and improving work ergonomics to mitigate and prevent the WRMSDs among workers in goldmines.

Determinants of COVID-19 vaccine uptake: evidence from a vulnerable global South setting.

OBJECTIVE: Studies are paying increasing attention to complex social determinants in explaining the variation in the rates COVID-19 vaccine uptake. This study examines the influence of various individual, contextual, and vaccine-related factors on COVID-19 vaccine uptake behaviour in a resource-scarce and vulnerable setting using a quantitative research approach. Using a multi-staged cluster sampling approach, 408 individuals from 204 households in Cape Coast, Ghana's tourism hub, were surveyed. Probit and logistic regression models were estimated to test the vaccine-related factors. RESULTS: A significant difference is observed between wait time and vaccination status (χ2 = 21.17; p = 0.000). Moreover, age and religion, as controlled variables, equally played significant roles in influencing the adoption of the vaccine. Other factors encompass the perceived risk of contracting COVID-19, the perceived benefits of the vaccine in relation to its side effects, and the level of trust individuals have in the concern of vaccine producers for their health. These findings call for targeted campaigns by the Ministry of Health, health facilities and other institutions promoting the COVID-19 vaccine. These actors should emphasize the benefits of vaccination, prioritize trust-building initiatives, and provide clear guidance on vaccination schedules, and manage waiting time.

Consumer risk perception towards pesticide-stained tomatoes in Uganda.

BACKGROUND: Tomatoes are consumed daily. Unfortunately, abuse of pesticide application by vegetable growers in Uganda increases risks of pesticide residue exposure among consumers, as they may be above Maximum Residue Limits (European Union Maximum Residue Limits used as a standard in Uganda). This study aimed to determine consumer attitudes and risk perceptions towards pesticide-stained tomatoes in Uganda to support interventions that could be used to reduce pesticide residue exposures in food. METHODS: A mixed methods cross-sectional study sampled 468 household consumers in four regions of Uganda, selecting one district (interventional project area) per region. In each district, about 60 household members were randomly selected from a total of three Sub Counties and interviewed. In addition, 9 tomato handlers (three tomato farmers, three tomato retailers, and three tomato wholesalers) participated in Focus Group Discussions (FGDs) per district. Collected data were entered into MS-Excel 13 and exported into Stata version 14.0 for cleaning and analysis at a 5% level of significance and 95% Confidence Intervals (CI). The proportion of risk perceptions and attitudes were computed and presented as percentages, while factors associated with risk perception were determined using Fisher exact test. Qualitative data collected under a traditional theory were analyzed using thematic content analysis. RESULTS: More than half, 54.2% (253/468), of the respondents were females, mean age was 37 years (SD = 13.13, ranging from 18 to 88 years). Half of the respondents, 50.9% (238/467), were farmers by occupation, and 40.3% (188/468) had completed upper primary education. Only 5.0% (20/396) of consumers reported a high-risk perception towards tomatoes stained with pesticide residues, the rest, 95.0% (376/396), were buying pesticide-stained tomatoes despite their awareness of the possible health effects. The main reason for buying the pesticide-stained tomatoes was that a majority, 59.0% (230/390), lacked an alternative to stained tomatoes like organically grown tomatoes. However, consumers generally had a negative attitude towards pesticide-stained tomatoes, with 67.0% (313/468) of the consumers disagreeing with the statement that tomatoes sold on the market are safe. Consumer risk perception was significantly associated with their awareness about residues in the tomatoes; where the proportion of consumers who were aware of the risk of pesticide-stained tomatoes was 42.8 times more likely not to buy stained tomatoes compared to the proportion of those who were not aware. OR, 42.8 (95% CI: 10.76-170.28). However, after Fisher-Exact tests analysis, level of education P(0.975), gender P(0.581), and age group P(0.680) were not associated with consumer risk perception (95% CI and 5% level of significance). CONCLUSION: Although the consumers had a negative attitude towards the pesticide-stained tomatoes, their risk perception towards them ranked low, with most consumers buying tomatoes stained with pesticide residues due to a lack of an alternative. Ministry of Agriculture extension service efforts should promote and emphasize community to start household-based organic kitchen gardens as the efforts for the establishment of a national pesticide residue monitoring center awaits.

Health service factors affecting the COVID-19 vaccination campaign in a Ghanaian metropolis: A qualitative exploratory study.

OBJECTIVE: The study sought to explore the perspectives of vaccinators on the health system factors that impacted the COVID-19 vaccination campaign. DESIGN: The study employed an exploratory-descriptive qualitative design. Key-informants' interviews were conducted using semi-structured guide to gather the data. Thematic analysis following the steps of Braun and Clark was conducted using ATLAS.ti software. SETTING: The study setting was the Cape Coast Metropolis where the Central Regional Health Directorate is located. The Directorate initiates and implements policy decisions across the region. It is also the only metropolis in the region that recorded about 5970 of the total COVID-19 cases recorded in Ghana. PARTICIPANTS: Eleven vaccinators who had been trained for the COVID-19 vaccination and had participated in the campaign for at least 6 months were purposively sampled through the Regional Public Health Unit. RESULTS: Four themes were derived from the data after analysis; 'vaccine-related issues'; 'staffing issues'; 'organising and planning the campaign' and 'surveillance and response systems'. Subthemes were generated under each major theme. Our results revealed the health service promoted the COVID-19 vaccination campaign through public education and ensured access to COVID-19 vaccines through the use of community outreaches. Also, the health service ensured adequate logistics supply for carrying out the campaign as well as ensured vaccinators were adequately equipped for adverse incidence reporting and management. Dissatisfaction among COVID-19 vaccinators attributed to low remuneration and delays in receiving allowances as well as shortfalls in efforts at securing transportation and a conducive venue for the vaccination exercise also emerged. Other challenges in the vaccination campaign were attributed to poor data entry platforms and limited access to internet facilities. CONCLUSION: This study highlights the health system's strategies and challenges during the COVID-19 vaccination campaign, emphasising the need for critical interventions to prevent low vaccination rates.

Mercury Exposure Among Artisanal and Small-Scale Gold Miners in Four Regions in Uganda.

BACKGROUND: Artisanal and small-scale gold mining is a human health concern, especially in low-income countries like Uganda due to the use of mercury (Hg) in the mining process. OBJECTIVE: The aim of the present study was to assess Hg exposure among artisanal and small-scale gold miners in Uganda through biologic monitoring parameters and Hg-related clinical manifestations. METHODS: A cross-sectional study was conducted from June to July 2018 among 183 miners from Ibanda (Western region), Mubende (Central region), Amudat (Karamoja region) and Busia (Eastern region) in Uganda. An interviewer-administered questionnaire and health assessment were used to collect socio-demographic, exposure and self-reported Hg poisoning symptoms. In addition, 41 urine, 41 blood and 26 environment samples were assessed. Descriptive statistics, Kruskal-Wallis test and Wilcoxon signed-rank test for comparison of Hg levels in urine and blood among miners were performed while logistic regression was used to assess associations between exposure and Hg poisoning-related symptoms. RESULTS: The miners ranged from 15 to 65 years old and were primarily male (72.6%). The majority (73.3%) had worked directly with Hg for an average duration of 5.3 years. Symptoms associated with working directly with Hg included chest pain (odds ratio (OR)=9.0, confidence interval (CI)=3.3 to 24.6), numbness (OR=8.5, CI=2.1 to 34.4), back pain (OR=6.2, CI= 2.2 to 17.5), fatigue and stress (OR=5.4, 2.0 to CI=14.9), headache (OR=4.7, CI=1.9 to 11.3), dizziness (OR=3.8, CI=1.5 to 9.7) joint pain (OR=3.2, CI=1.3 to 8.3) and respiratory problems (3.2, 1.0 to 10.1). Statistically significant differences in Hg levels with p-values less than 0.05 were observed across district, gender and type of work. Mubende had the highest blood and urine levels (136 µg/l and 105.5 µg/l) in comparison with Busia (60 µg/l and 70.6 µg/l) and Ibanda (43 µg/l and 58 µg/l). Females (84.7 µg/l), panners (109 µg/l) and those with knowledge of occupational health and safety measures (95.6 µg/l) reported higher levels of Hg in urine. The average levels of Hg in water and soil samples were 23.79 µg/l and 0.21 µg/l, respectively. CONCLUSIONS: Variation in Hg levels were attributed to varied duration of exposure across geographical sites. There was considerable exposure to Hg as indicated by both clinical manifestations and biologic parameters among miners in Uganda with Hg in urine exceeding the recommended thresholds. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: Ethical approval was obtained from the Makerere University School of Health Science Institutional Review Board (reference number SHSREC REF 2018-2019) and Uganda National Council for Science and Technology (reference number SS 4577). COMPETING INTERESTS: The authors declare no competing financial interests.

Pesticide knowledge, practice and attitude and how it affects the health of small-scale farmers in Uganda: a cross-sectional study.

BACKGROUND: Over the past years there has been an increase in the use of pesticides in developing countries. This study describes pesticide use among small-scale farmers in Uganda and analyses predictors of pesticide poisoning (intoxication) symptoms. METHOD: A cross-sectional study was conducted using a standardized questionnaire. Some 317 small-scale farmers in two districts in Uganda were interviewed about pesticide use, knowledge and attitude, symptoms of intoxication, personal protective equipment (PPE) and hygiene. The risk of reporting symptoms was analysed using logistic regression analysis. RESULTS: The most frequently used pesticides belonged to WHO class II. The farmers had poor knowledge about pesticide toxicity, and the majority did not use appropriate PPE nor good hygiene when handling pesticides. There was no significant association between the number of times of spraying with pesticides and self-reported symptoms of pesticide poisoning. The only significant association was between blowing and sucking the nozzle of the knapsack sprayer and self-reported symptoms of pesticide intoxication (OR: 2.13. 95% CI: 1.09 - 4.18). CONCLUSION: Unlike the practice in several other developing countries, small-scale farmers in Uganda do not use the most hazardous pesticides (WHO class 1a and 1b). However use of WHO class II pesticides and those of lower toxicity is seen in combination with inadequate knowledge and practice among the farmers. This poses a danger of acute intoxications, chronic health problems and environmental pollution. Training of farmers in Integrated Pest Management (IPM) methods, use of proper hygiene and personal protective equipment when handling pesticides should be promoted.