NRU :: Browsing by Author "Atukunda, Esther C."

Browsing by Author "Atukunda, Esther C."

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Challenges in Accessing Maternal and Child Health Services During COVID-19 and the Potential Role of Social Networking Technologies
(Digital Health, 2022) Musiimenta, Angella; Tumuhimbise, Wilson; Atukunda, Esther C.; Ayebaza, Sandrah; Kobutungi, Phionah; Zender, Raphael; Haberer, Jessica E.
The COVID-19 pandemic causes new challenges to women and their babies who still need to access postnatal care amidst the crisis. The novel application of social network technologies (SNTs) could potentially enhance access to healthcare during this difficult time. This study describes the challenges experienced in accessing maternal and child health services by women with limited or no education during this COVID-19 pandemic and discusses the potential of SNTs to support maternal and child health amidst this crisis. We administered surveys to women who had recently given birth in a rural setting and interviewed a purposively selected subset to ascertain their experiences of accessing maternal and child health services during the COVID-19 pandemic. Our analysis involved descriptive analysis of quantitative data using STATA 13 to describe study participants’ characteristics, and content analysis of qualitative data to derive categories describing maternal health challenges. Among 50 women, the median age was 28 years (interquartile range 24–34), 42 (84%) completed upper primary education. Access to the health facility was constrained by transport challenges, fear of contracting COVID-19, and delays at the facility. Due to the COVID-19 crisis, 42 (84%) women missed facility visits, 46 (92%) experienced financial distress, 43 (86%) had food insecurity, and 44 (88%) felt stressed. SNTs can facilitate remote and timely access to health services and information, and enable virtual social connections and support. SNTs have the potential to mitigate the challenges faced in accessing maternal and child health services amidst the ongoing COVID-19 pandemic.
Correction: Potential Cost-Effectiveness of Prenatal Distribution of Misoprostol for Prevention of Postpartum Hemorrhage in Uganda
(Plos one, 2017-03-31) Lubinga, Solomon J.; Atukunda, Esther C.; Wasswa-Ssalongo, George; Babigumira, Joseph B.
The correct sentences are “In the base-case analysis, misoprostol distribution lowered the expected incidence of PPH by 1.2% (95% credibility interval (CrI): 0.55%, 1.95%), mortality by 0.08% (95% CrI: 0.04%, 0.13%) and DALYs by 0.02 (95% CrI: 0.01, 0.03).” and “ICERs were US$181 (95% CrI: 81, 443) per DALY averted from a governmental perspective, and US$64 (95% CrI: -84, 260) per DALY averted from a modified societal perspective.”
Differences in Symptom Severity and Quality of Life among Patients with Cancer Using Conventional Therapies with/ without Herbal Medicines in Uganda: A Cross-Sectional Study
(Asian Pacific Journal of Cancer Prevention: APJCP, 2023-09-24) Asiimwe, John Baptist; Nagendrappa, Prakash B.; Jatho, Alfred; Kamatenesi, Maud M.; Atukunda, Esther C.
Patients with cancer experience numerous symptoms related to cancer and treatment side effects that reduce their quality of life (QOL). Although herbal medicine (HM) is used to manage such symptoms by patients in sub-Saharan Africa, data on patients’ perceived clinical outcomes are limited. We compared differences in QOL and symptom severity between patients with cancer using HM plus conventional therapies (i.e., chemotherapy, hormonal therapy, radiotherapy, surgery) and those using conventional therapies alone. This cross-sectional study included patients with cancer aged >18 years who were consecutively sampled and completed a researcher-administered questionnaire between December 2022 and January 2023. Specifically, data was collected using The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the MD Anderson Symptom Inventory for Traditional Chinese Medicine (MDASI-TCM). Data were analyzed using descriptive statistics and chi-square and logistic regression analyses. Of 400 participants (67.5% female), 49% (n=195) used HM plus conventional therapies and 51% (n=205) used conventional therapies alone. Most participants were aged >38 years (73.3%; median age 47 years). A univariate analysis showed the HM plus conventional therapies group had better mean scores for most QOL and symptom severity measures than the conventional therapies alone group. However, only role functioning significantly differed (p=0.046) in the bivariate analysis. There were no statistically significant differences between the two groups after confounder adjustment for all others measures of symptom severity and QOL. HM plus conventional therapies may offer minimal benefits or differences for clinical outcomes among patients with cancer. However, our findings have clinical, research, and public health implications for Uganda and other sub-Saharan African settings.
A Mobile Health App May Improve Maternal and Child Health Knowledge and Practices among Rural Women with Limited Education in Uganda. A Pilot Randomized Controlled Trial
(JAMIA open, 2022) Musiimenta, Angella; Tumuhimbise, Wilson; Atukunda, Esther C.; Mugaba, Aaron T.; Asasira, Justus; Katusiime, Jane; Zender, Raphael; Pinkwart, Niels; Mugyenyi, Godfrey Rwambuka; Haberer, Jessica E.
This article describes the impact of a mobile health app (MatHealth App) on maternal and child health knowledge and practices among women with limited education. Pregnant women initiating antenatal care (ANC) were randomized (1:1) to the MatHealth App versus routine care. Participants were followed until 6 weeks after delivery. Questionnaires for assessing knowledge and practices were administered to participants from both arms at baseline and endline. Using logistic regression, we estimated the difference in odds of having maternal health knowledge. We reviewed clinic records to capture maternal health practices. Of the 80 enrolled participants, 69 (86%) completed the study with a median follow-up of 6 months. Women in the MatHealth arm had 8.2 (P ¼ .19), 3.6 (P ¼ .14), and 6.4 (P ¼ .25), respectively higher odds of knowing (1) the recommended gestation period for starting ANC, (2) the recommended number of ANC visits, and (3) the timing and frequency of recommended human immunodeficiency virus (HIV) testing, respectively, compared to those in the routine care arm. All women in the MatHealth App arm exclusively breastfed their babies, and brought them at 6 weeks for HIV testing, compared to the routine care arm. Just over half of the women attended at least 4 prenatal visits across the 2 arms. The main reason for noncompliance to ANC appointments was a lack of transport to the clinic. The app increased knowledge and practices although not reaching statistical significance. Future efforts can focus on addressing social and economic issues and assessing clinical outcomes.
A Mobile Health App may Improve Maternal and Child Health Knowledge and Practices among Rural Women with Limited Education in Uganda: A Pilot Randomized Controlled Trial
(JAMIA open, 2022) Musiimenta, Angella; Tumuhimbise, Wilson; Atukunda, Esther C.; Mugaba, Aaron T.; Asasira, Justus; Katusiime, Jane; Zender, Raphael; Mugyenyi, Godfrey Rwambuka; Haberer, Jessica E.
This article describes the impact of a mobile health app (MatHealth App) on maternal and child health knowledge and practices among women with limited education. Pregnant women initiating antenatal care (ANC) were randomized (1:1) to the MatHealth App versus routine care. Participants were followed until 6 weeks after delivery. Questionnaires for assessing knowledge and practices were administered to participants from both arms at baseline and endline. Using logistic regression, we estimated the difference in odds of having maternal health knowledge. We reviewed clinic records to capture maternal health practices. Of the 80 enrolled participants, 69 (86%) completed the study with a median follow-up of 6 months. Women in the MatHealth arm had 8.2 (P = .19), 3.6 (P = .14), and 6.4 (P = .25), respectively higher odds of knowing (1) the recommended gestation period for starting ANC, (2) the recommended number of ANC visits, and (3) the timing and frequency of recommended human immunodeficiency virus (HIV) testing, respectively, compared to those in the routine care arm. All women in the MatHealth App arm exclusively breastfed their babies, and brought them at 6 weeks for HIV testing, compared to the routine care arm. Just over half of the women attended at least 4 prenatal visits across the 2 arms. The main reason for noncompliance to ANC appointments was a lack of transport to the clinic. The app increased knowledge and practices although not reaching statistical significance. Future efforts can focus on addressing social and economic issues and assessing clinical outcomes
Potential Cost-Effectiveness of Prenatal Distribution of Misoprostol for Prevention of Postpartum Hemorrhage in Uganda
(PloS one, 2015-11-11) Lubinga, Solomon J.; Atukunda, Esther C.; Wasswa-Ssalongo, George; Babigumira, Joseph B.
In settings where home birth rates are high, prenatal distribution of misoprostol has been advocated as a strategy to increase access to uterotonics during the third stage of labor to prevent postpartum hemorrhage (PPH). Our objective was to project the potential cost-effectiveness of this strategy in Uganda from both governmental (the relevant payer) and modified societal perspectives. To compare prenatal misoprostol distribution to status quo (no misoprostol distribution), we developed a decision analytic model that tracked the delivery pathways of a cohort of pregnant women from the prenatal period, labor to delivery without complications or delivery with PPH, and successful treatment or death. Delivery pathway parameters were derived from the Uganda Demographic and Health Survey. Incidence of PPH, treatment efficacy, adverse event and case fatality rates, access to misoprostol, and health resource use and cost data were obtained from published literature and supplemented with expert opinion where necessary. We computed the expected incidence of PPH, mortality, disability adjusted life years (DALYs), costs and incremental cost effectiveness ratios (ICERs). We conducted univariate and probabilistic sensitivity analyses to examine robustness of our results. In the base-case analysis, misoprostol distribution lowered the expected incidence of PPH by 1.0% (95% credibility interval (CrI): 0.55%, 1.95%), mortality by 0.08% (95% CrI: 0.04%, 0.13%) and DALYs by 0.02 (95% CrI: 0.01, 0.03). Mean costs were higher with prenatal misoprostol distribution from governmental by US$3.3 (95% CrI: 2.1, 4.2) and modified societal (by US$1.3; 95% CrI: -1.6, 2.8) perspectives. ICERs were US$191 (95% CrI: 82, 443) per DALY averted from a governmental perspective, and US$73 (95% CI: -86, 256) per DALY averted from a modified societal perspective. Conclusions Prenatal distribution of misoprostol is potentially cost-effective in Uganda and should be considered for national-level scale up for prevention of PPH.
Sublingual Misoprostol versus Intramuscular Oxytocin for Prevention of Postpartum Hemorrhage in Uganda: A Double-Blind Randomized Non-Inferiority Trial
(PLoS medicine, 2014-11-04) Atukunda, Esther C.; Obua, Celestino; Mugyenyi, Godfrey R.; Twagirumukiza, Marc; Agaba, Amon G.
Postpartum hemorrhage (PPH) is a leading cause of maternal death in sub-Saharan Africa. Although the World Health Organization recommends use of oxytocin for prevention of PPH, misoprostol use is increasingly common owing to advantages in shelf life and potential for sublingual administration. There is a lack of data about the comparative efficacy of oxytocin and sublingual misoprostol, particularly at the recommended dose of 600 µg, for prevention of PPH during active management of labor.
Suboptimal Antiretroviral Drug Levels and Virologic Failures among PLHIV at a Rural Referral Hospital in South Western Uganda: A Descriptive Crosssectional Study
(Research Square, 2020) Samba Twinomujuni, Silvano; Engeu Ogwang, Patrick; Roelofsen, Felicitas; Mukonzo, Jackson K.; Atukunda, Esther C.
Achieving favorable HIV treatment outcomes is a major challenge, particularly due to nonadherence and consequent sub-therapeutic plasma antiretroviral drug levels. This is often complicated by the development of resistant strains due to mutations. Monitoring antiretroviral drug levels in the blood of patients enrolled on ART can reveal if levels are too high, enough, or too low. High levels may lead to dose-dependent side effects and sub-therapeutic levels could promote treatment failure and resistance. In Uganda, as part of routine HIV care, plasma antiretroviral drug level is estimated indirectly by clinic-based pill counts and patient self-reported adherence, which give no evidence of ingested medication. This study aimed at exploring steady-state nevirapine and efavirenz drug levels in HIV patients accessing ART at a rural referral hospital in South Western Uganda. Methods: This study was nested into a randomized clinical trial that evaluated the effect of Artemisia annua L. and Moringa oleifera on immunological response and viral load among persons living with HIV (PLHIV). In the parent study, 250 HIV-infected patients with continued immunologic suppression (CD4 count < 350cells/μL) despite a minimum of one-year on ART were enrolled. Out of 250 clinical trial participants, 95 were randomly selected for steady-state efavirenz and nevirapine plasma concentration sampling having taken the last at bedtime. Additionally, CD4 count, HIV load, liver, and renal function tests were determined. Participants were also interviewed for adherence, and factors that affect blood drug levels.
The Meaning of Caring for Patients with Cancer among Traditional Medicine Practitioners in Uganda: A grounded theory approach
(PLOS Global Public Health, 2023-07-17) Asiimwe, John Baptist; Nagendrappa, Prakash B.; Atukunda, Esther C.; Nambozi, Grace; Ogwang, Patrick E.; Kamatenesi, Maud M.
Traditional medicine practitioners (TMPs) are a critical part of healthcare systems in many sub-Saharan African countries and play vital roles in caring for patients with cancer. Despite some progress in describing TMPs’ caring experiences in abstract terms, literature about practice models in Africa remains limited. This study aimed to develop a substantive theory to clarify the care provided by TMPs to patients with cancer in Uganda. This study adhered to the principal features of the modified Straussian grounded theory design. Participants were 18 TMPs caring for patients with cancer from 10 districts in Uganda, selected by purposive and theoretical sampling methods. Researcher-administered in-depth interviews were conducted, along with three focus group discussions. Data were analyzed using constant comparative analysis. The core category that represented TMPs’ meaning of caring for patients with cancer was “Restoring patients’ hope in life through individualizing care.” TMPs restored patients’ hope through five main processes: 1) ensuring continuity in the predecessors’ role; 2) having full knowledge of a patient’s cancer disease; 3) restoring hope in life; 4) customizing or individualizing care, and 5) improving the patient’s condition/health. Despite practice challenges, the substantive theory suggests that TMPs restore hope for patients with cancer in a culturally sensitive manner, which may partly explain why patients with cancer continue to seek their services. The findings of this study may guide research, education, and public health policy to advance traditional medicine in sub-Saharan Africa.
The meaning of caring for patients with cancer among traditional medicine practitioners in Uganda: A grounded theory approach
(PLOS Global Public Health, 2023-07-17) Asiimwe, John Baptist; Atukunda, Esther C.; Nambozi, Grace; Ogwang, Patrick E.; Kamatenesi, Maud M.
Traditional medicine practitioners (TMPs) are a critical part of healthcare systems in many sub-Saharan African countries and play vital roles in caring for patients with cancer. Despite some progress in describing TMPs’ caring experiences in abstract terms, literature about practice models in Africa remains limited. This study aimed to develop a substantive theory to clarify the care provided by TMPs to patients with cancer in Uganda. This study adhered to the principal features of the modified Straussian grounded theory design. Participants were 18 TMPs caring for patients with cancer from 10 districts in Uganda, selected by purposive and theoretical sampling methods. Researcher-administered in-depth interviews were conducted, along with three focus group discussions. Data were analyzed using constant comparative analysis. The core category that represented TMPs’ meaning of caring for patients with cancer was “Restoring patients’ hope in life through individualizing care.” TMPs restored patients’ hope through five main processes: 1) ensuring continuity in the predecessors’ role; 2) having full knowledge of a patient’s cancer disease; 3) restoring hope in life; 4) customizing or individualizing care, and 5) improving the patient’s condition/health. Despite practice challenges, the substantive theory suggests that TMPs restore hope for patients with cancer in a culturally sensitive manner, which may partly explain why patients with cancer continue to seek their services. The findings of this study may guide research, education, and public health policy to advance traditional medicine in sub-Saharan Africa.
The Traditional Medicine Practitioner’s Concept of Cancer, Herbal Medicine use and the Patients Perceived Benefits (Clinical outcomes) in Selected Districts of Central Uganda: An Exploratory Study Protocol
(Research Square, 2021-10-01) Asiimwe, John Baptist; Nagendrappa, Prakash B.; Atukunda, Esther C.; Nambozi, Grace; Ogwang, Patrick E.; Sarki, Ahmed M.; Kamatenesi, Maud M.
In sub-Saharan Africa, herbal medicine for cancer is dispensed by traditional medicine practitioners (TMPs) to a large extent, who may not have adequate knowledge about the disease and this has been found to contribute to the late presentation of cancer patients to clinics and hospitals leading to poor patient outcomes.

Browsing by Author "Atukunda, Esther C."

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