Browsing by Author "Awor, Phyllis"

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    Community Engagement in Social Innovation Research: A Global Sequential Mixed Methods Analysis
    (ResearchSquare, 2022) Ahumuza, Emmanuel; Moscibrodzki, Patricia; Awor, Phyllis
    Social innovation in health provides innovative solutions to address healthcare delivery gaps and it relies on engaging community. However, little is known about factors that influence community engagement in health research. The study sought an in-depth understanding of elements of community engagement in social innovations identified by the global social innovation in health initiative network.
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    Effectiveness of Peer-supervision on Paediatric Fever Treatment among Registered Private Drug Sellers in East-Central Uganda: An Interrupted Time Series Analysis
    (Authorea Preprints, 2020) Bagonza, Arthur; Kitutu, Freddy; Peterson, Stefan; Martensson, Andreas; Mutto, Milton; Awor, Phyllis; Mukanga, David; Wamani, Henry
    Rationale, aims and objectives: Appropriate treatment of paediatric fever in rural areas remains a challenge and may be partly due to inadequate supervision of licensed drug sellers. This study assessed the effectiveness of peer-supervision among drug sellers on appropriate treatment of pneumonia symptoms, uncomplicated malaria and non-bloody diarrhoea among children less than five years of age in the intervention (Luuka) and comparison (Buyende) districts, in East-Central Uganda. Methods: Data on pneumonia symptoms, uncomplicated malaria and non-bloody diarrhoea among children less than five years of age was abstracted from drug shop sick child registers over a 12-month period; six months before and six months after introduction of peer-supervision. Interrupted time series was applied to determine the effectiveness of the peer-supervision intervention on appropriate treatment of pneumonia, uncomplicated malaria and non-bloody diarrhoea among children less than five years of age attending drug shops in East Central Uganda. Results: The proportion of children treated appropriately for pneumonia symptoms was 10.84% (P<0.05, CI = [1.75, 19.9]) higher, for uncomplicated malaria was 1.46% (P = 0.79, CI = [-10.43, 13.36]) higher, and for non-bloody diarrhoea was 4.00% (p <0.05, CI = [-7.95, -0.13]) lower in the intervention district than the comparison district, respectively. Post-intervention trend results showed an increase of 1.21% (p =0.008, CI = [0.36, 2.05]) in the proportion appropriately treated for pneumonia symptoms, no difference in appropriate treatment for uncomplicated malaria, and a reduction of 1% (p <0.06, CI = [-1.95, 0.02]) in the proportion of children appropriately treated for nonbloody diarrhoea, respectively. Conclusions: Peer-supervision increased the proportion of children less than five years of age that received appropriate treatment for pneumonia symptoms but not for uncomplicated malaria and non-bloody diarrhoea. Implementation of community level interventions to improve paediatric fever management should consider including peersupervision among drug sellers.
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    Inclusion of private sector in district health systems; case study of private drug shops implementing modified Integrated Community Case Management (iCCM) strategy in Rural Uganda
    (BMC Health Services Research, 2014) Kitutu, Freddy; Mayora, Chrispus; Awor, Phyllis; Birger, Forsberg; Peterson, Stefan; Wamani, Henry
    Uganda Ministry of Health passed the Public Private Partnership for Health (PPPH) policy to strengthen the health system by leveraging strategic advantages of private healthcare providers [1]. The National Malaria program has gone further to develop a malaria case management strategy through a multi-stakeholder consultative process [2]. Makerere University School of Public Health (MakSPH) partnered with Mbarara district to implement the iCCM strategy in private licensed drug shops in rural areas. The partnership aimed to increase access to quality medicines and point of care diagnostics for child febrile illnesses, minimize excess use of antimalarials and antibiotics, share information of cases diagnosed and treated at the drug shops and promote child survival.
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    It could be viral but you don’t know, you have not diagnosed it: health worker challenges in managing non-malaria paediatric fevers in the low transmission area of Mbarara District, Uganda
    (Malaria Journal, 2016) Johansson, Emily White; Kitutu, Freddy Eric; Mayora, Chrispus; Awor, Phyllis; Peterson, Stefan Swartling; Wamani, Henry; Hildenwall, Helena
    In 2012, Uganda initiated nationwide deployment of malaria rapid diagnostic tests (RDT) as recommended by national guidelines. Yet growing concerns about RDT non-compliance in various settings have spurred calls to deploy RDT as part of enhanced support packages. An understanding of how health workers currently manage non-malaria fevers, particularly for children, and challenges faced in this work should also inform efforts. Methods: A qualitative study was conducted in the low transmission area of Mbarara District (Uganda). In-depth interviews with 20 health workers at lower level clinics focused on RDT perceptions, strategies to differentiate nonmalaria paediatric fevers, influences on clinical decisions, desires for additional diagnostics, and any challenges in this work. Seven focus group discussions were conducted with caregivers of children under 5 years of age in facility catchment areas to elucidate their RDT perceptions, understandings of non-malaria paediatric fevers and treatment preferences. Data were extracted into meaning units to inform codes and themes in order to describe response patterns using a latent content analysis approach. Results: Differential diagnosis strategies included studying fever patterns, taking histories, assessing symptoms, and analysing other factors such as a child’s age or home environment. If no alternative cause was found, malaria treatment was reportedly often prescribed despite a negative result. Other reasons for malaria over-treatment stemmed from RDT perceptions, system constraints and provider-client interactions. RDT perceptions included mistrust driven largely by expectations of false negative results due to low parasite/antigen loads, previous anti-malarial treatment or test detection of only one species. System constraints included poor referral systems, working alone without opportunity to confer on difficult cases, and lacking skills and/or tools for differential diagnosis. Provider-client interactions included reported caregiver RDT mistrust, demand for certain drugs and desire to know the ‘exact’ disease cause if not malaria. Many health workers expressed uncertainty about how to manage non-malaria paediatric fevers, feared doing wrong and patient death, worried caregivers would lose trust, or felt unsatisfied without a clear diagnosis. Conclusions: Enhanced support is needed to improve RDT adoption at lower level clinics that focuses on empowering providers to successfully manage non-severe, non-malaria paediatric fevers without referral. This includes building trust in negative results, reinforcing integrated care initiatives (e.g., integrated management of childhood illness) and fostering communities of practice according to the diffusion of innovations theory.
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    Policy Challenges Facing the Scale Up of Integrated Community Case Management (iCCM) in Uganda
    (International Journal of Health Policy and Management, 2021) Awor, Phyllis; Nakayaga Kalyango, Joan; Stålsby Lundborg, Cecilia; Ssengooba, Freddie; Eriksen, Jaran; Rutebemberwa, Elizeus
    Integrated Community Case Management (iCCM) of malaria, pneumonia and diarrhoea is an equity focused strategy, to increase access to care for febrile illness in children under-5 years of age, in rural communities. Lay community members are trained to diagnose and treat malaria, pneumonia and diarrhoea in children, and to identify and refer very ill children. Today, many low-income countries including Uganda, have a policy for iCCM which is being rolled out through public sector community health workers (CHWs). Ten years after the introduction of the iCCM strategy in Uganda, it is important to take stock and understand the barriers and facilitators affecting implementation of the iCCM policy. Methods: We conducted an iCCM policy analysis in order to identify the challenges, enablers and priorities for scale-up of the iCCM strategy in Uganda. This was a qualitative case study research which included a document review (n = 52) and key informant interviews (n = 15) with Ugandan stakeholders. Interviews were conducted in 2017 and the desk review included literature up to 2019. Results: This paper highlights the iCCM policy trajectory since 2010 in Uganda and includes a policy timeline. The iCCM policy process was mainly led by international agencies from inception, with little ownership of the government. Many implementation challenges including low government funding, weak coordination and contradicting policies were identified, which could contribute to the slow scale up of the iCCM program. Despite the challenges, many enablers and opportunities also exist within the health system, which should be further harnessed to scale up iCCM in Uganda. These enabling factors include strong community commitment, existing policy instruments and the potential of utilizing also the private sector for iCCM implementation. Conclusion: The iCCM program in Uganda needs to be strengthen through increased domestic funding, strong coordination and a focus on monitoring, evaluation and operational research.
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    Regulatory Inspection of Registered Private Drug Shops in East-Central Uganda—What it is Versus what it Should Be: A Qualitative Study
    (Journal of Pharmaceutical Policy and Practice, 2020) Bagonza, Arthur; Peterson, Stefan; Mårtensson, Andreas; Wamani, Henry; Awor, Phyllis; Mutto, Milton; Musoke, David; Gibson, Linda; Kitutu, Freddy Eric
    Regulatory inspection of private drug shops in Uganda is a mandate of the Ministry of Health carried out by the National Drug Authority. This study evaluated how this mandate is being carried out at national, district, and drug shop levels. Specifically, perspectives on how the inspection is done, who does it, and challenges faced were sought from inspectors and drug sellers.Six key informant interviews (KIIs) were held with inspectors at the national and district level, while eight focus group discussions (FGDs) were conducted among nursing assistants, and two FGDs were held with nurses. The study appraised current methods of inspecting drug sellers against national professional guidelines for licensing and renewal of class C drug shops in Uganda. Transcripts were managed using Atlas ti version 7 (ATLAS.ti GmbH, Berlin) data management software where the thematic content analysis was done.Five themes emerged from the study: authoritarian inspection, delegated inspection, licensing, training, and bribes. Under authoritarian inspection, drug sellers decried the high handedness used by inspectors when found with expired or no license at all. For delegated inspection, drug sellers said that sometimes, inspectors send health assistants and sub-county chiefs for inspection visits. This cadre of people is not recognized by law as inspectors. Inspectors trained drug sellers on how to organize their drug shops better and how to use new technologies such as rapid diagnostic tests (RDTs) in diagnosing malaria. Bribes were talked about mostly by nursing assistants who purported that inspectors were not interested in inspection per se but collecting illicit payments from them. Inspectors said that the facilitation they received from the central government were inadequate for a routine inspection.The current method of inspecting drug sellers is harsh and instills fear among drug sellers. There is a need to establish a well-recognized structure of inspection as well as establish channels of dialogue between inspectors and drug sellers if meaningful compliance is to be achieved. The government also needs to enhance both human and financial resources if meaningful inspection of drug sellers is to take place.
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    Regulatory inspection of registered private drug shops in East-Central Uganda—what it is versus what it should be: a qualitative study
    (Journal of Pharmaceutical Policy and Practice, 2020) Bagonza, Arthur; Peterson, Stefan; Mårtensson, Andreas; Wamani, Henry; Awor, Phyllis; Mutto, Milton; Musoke, David; Gibson, Linda; Kitutu, Freddy Eric
    Regulatory inspection of private drug shops in Uganda is a mandate of the Ministry of Health carried out by the National Drug Authority. This study evaluated how this mandate is being carried out at national, district, and drug shop levels. Specifically, perspectives on how the inspection is done, who does it, and challenges faced were sought from inspectors and drug sellers. Methods: Six key informant interviews (KIIs) were held with inspectors at the national and district level, while eight focus group discussions (FGDs) were conducted among nursing assistants, and two FGDs were held with nurses. The study appraised current methods of inspecting drug sellers against national professional guidelines for licensing and renewal of class C drug shops in Uganda. Transcripts were managed using Atlas ti version 7 (ATLAS.ti GmbH, Berlin) data management software where the thematic content analysis was done. Results: Five themes emerged from the study: authoritarian inspection, delegated inspection, licensing, training, and bribes. Under authoritarian inspection, drug sellers decried the high handedness used by inspectors when found with expired or no license at all. For delegated inspection, drug sellers said that sometimes, inspectors send health assistants and sub-county chiefs for inspection visits. This cadre of people is not recognized by law as inspectors. Inspectors trained drug sellers on how to organize their drug shops better and how to use new technologies such as rapid diagnostic tests (RDTs) in diagnosing malaria. Bribes were talked about mostly by nursing assistants who purported that inspectors were not interested in inspection per se but collecting illicit payments from them. Inspectors said that the facilitation they received from the central government were inadequate for a routine inspection. Conclusion: The current method of inspecting drug sellers is harsh and instills fear among drug sellers. There is a need to establish a well-recognized structure of inspection as well as establish channels of dialogue between inspectors and drug sellers if meaningful compliance is to be achieved. The government also needs to enhance both human and financial resources if meaningful inspection of drug sellers is to take place.
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    Social, Emotional and Economic Empowerment through Knowledge of Group Support Psychotherapy Project, Uganda
    (TDR, 2020) Awor, Phyllis; Ahumuza, Emmanuel
    The Social, Emotional and Economic empowerment through Knowledge of Group Support Psychotherapy (SEEK-GSP) project is implemented by Makerere University in collaboration with the Ministry of Health. The project aims at narrowing the treatment gap for depression among people living HIV using group support psychotherapy delivered by trained lay health workers in Northern Uganda. Globally, the advent of antiretroviral therapy has led to improved quality of life of people living with HIV (Mugavero et al., 2009; Oguntibeju, 2012), reduced HIV related death (UNAIDS, 2018) and reduced new HIV infections (Bavinton et al., 2018; Cohen et al., 2016; Rodger et al., 2016). However, Other HIV/AIDS related challenges like depression still prevail. Previous studies have found that people living with HIV are two to four times more likely to suffer from depression compared to the general population (Ciesla and Roberts, 2001; Do et al., 2014; Remien et al., 2019). In Uganda, the prevalence of depression among people living with HIV/AIDS is estimated to be between 9 - 25% (Kinyanda et al., 2017; Nakimuli-Mpungu et al., 2011). Despite this, most of HIV treatment facilities in Sub Saharaan Africa including Uganda do not screen for depression among people living with HIV.