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.
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    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.
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    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
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    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.