Browsing by Author "Guwatudde, D."
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Item The Challenge to Restoring Basic Health Care in Uganda(Social Science & Medicine, 1998) Okello, D. O.; Lubanga, R.; Guwatudde, D.; Sebina-Zziwa, A.This paper presents the results of a health facility survey conducted in Uganda between June 1992 and December 1993. The survey covered both government and non-government organisation (NGO) facilities from 10 districts in the five regions of the country. The main objective of the survey was to assess resource use, costs and financing of health facilities. The survey found differences between resource levels of NGOs and government facilities. Government facilities were inadequately maintained, and mostly in a state of disrepair. The user fee scheme that had been recently introduced in some government units to meet running costs was not only inadequate, but was not being used to meet the needs of consumers. In addition, most available resources, including human resources, were concentrated in hospitals. As a result, there was heavy demand for hospital services and less use of services in the lower level facilities. And furthermore, staff in government facilities were paid much less than staff working for NGOs, who not only got better pay but also in-kind forms of rewards, which made them better motivated to work. The number of qualified staff, particularly for primary health care, was grossly inadequate, and most of the work in local facilities was being done by unqualified employees, such as ward maids and dressers. In order to alleviate some of the problems identified, particularly in government facilities, there is a need to explore ways in which more can be done with the available resources to improve the efficiency of health services. The user charge system could be effective in improving the resource base of the health facilities, but it must result in visible improvement in the quality of services for consumers to be willing to pay. Collection methods should be standardized, and expenditures supervised. As part of the government's decentralization programme, districts should be given the power to recruit and fire personnel. Once this authority is in place, the district should consider employing fewer personnel at all levels and aim to pay them a living wage.Item Evidence-based monitoring and evaluation of the faith-based approach to HIV prevention among Christian and Muslim youth in Wakiso district in Uganda(African health sciences, 2012) Kagimu, M.; Kaye, S.; Ainomugisha, D.; Lutalo, I.; Walakira, Y.; Guwatudde, D.; Rwabukwali, C.: The Islamic Medical Association of Uganda, has been implementing the faith-based approach to HIV prevention without baseline data on expected positive outcomes. Objectives: To establish evidence-based baseline data on expected positive outcomes of the faith-based approach to HIV prevention. Methods: A cross-sectional study of 15-24 year-old youths was analyzed for significant associations between HIV infections, risky behaviors, and religiosity. Results: HIV prevalence was 3.6% among Christians and 2.4% among Muslims. Abstaining from sex among teenagers was at 54% for Christians and 58% for Muslims. Being faithful in marriage among males was at 41% for Christians and 34% for Muslims and among females it was 65% for Christians and 69% for Muslims. Praying privately was associated with lower HIV infections and was observed among 60% of Christians. Sujda, the hyperpigmented marker of regular prayers on the forehead of Muslims was associated with lower HIV infections and observed in 42% of them. Ever drank alcohol was associated with higher HIV prevalence and observed in 52% of Christians and 17% of Muslims. Male circumcision rates were 15% for Christians and 98% for Muslims. Conclusion: A sero-behavioral-religiosity survey can provide evidence-based data for monitoring and evaluation of the faith-based approach to HIV prevention.Item Injury patterns in rural and urban Uganda(Injury prevention, 2001) Kobusingye, O.; Guwatudde, D.; Lett, R.To describe and contrast injury patterns in rural and urban Uganda. Settings—One rural and one urban community in Uganda. Methods—Community health workers interviewed adult respondents in households selected by multistage sampling, using a standardized questionnaire. Results—In the rural setting, 1673 households, with 7427 persons, were surveyed. Injuries had an annual mortality rate of 92/100 000 persons, and disabilities a prevalence proportion of 0.7%. In the urban setting 2322 households, with 10 982 people, were surveyed. Injuries had an annual mortality rate of 217/100 000, and injury disabilities a prevalence proportion of 2.8%. The total incidence of fatal, disabling, and recovered injuries was 116/1000/ year. Leading causes of death were drowning in the rural setting, and road traffic in the city. Conclusion—Injuries are a substantial burden in Uganda, withmuch higher rates than those in mostWestern countries. The urban population is at a higher risk than the rural population, and the patterns of injury differ. Interventions to control injuries should be a priority in Uganda.Item Prevalence factors associated with Hypertension in Rukungiri District, Uganda - A Community-Based Study(African health sciences, 2009) Wamala, J. F.; Karyabakabo, Z.; Ndungutse, D.; Guwatudde, D.Hypertension is a growing public health problem in Uganda and Africa as a whole. We conducted a study to determine the prevalence and identify factors associated withy hypertension among residents of the rural district of Rukungiri, Uganda. Methods: A community-based cross-sectional study design was used to conduct this study. Between January and February 2006, a random sample of consenting district residents, aged 20 years or older were enrolled to participate in this study. Trained research assistants administered a standardized questionnaire and performed the physical measurements. The questionnaire collected data on demographics, social economic and exposure history to various potential risk factors for hypertension. Hypertension was defined as systolic blood pressure (BP) equal or greater than 140mmHg and/or diastolic BP equal or greater than 90mmHg, and/or being on regular anti-hypertensive therapy. Logistic regression analysis was used to identify factors associated with hypertension. Results: Of the 842 study participants, 252 were hypertensive. The age-standardized prevalence of hypertension was 30.5%, with a 95% Confidence Interval (CI) of 26.6 - 34.3%. Factors found to be associated with hypertension included: past alcohol use, Odds Ratio (OR)=2.28, [1.42 - 3.64], present alcohol use OR=1.64 [1.12 - 2.43], being overweight OR=1.95 [1.37 2.79], obesity OR=5.07 [2.79 - 9.21], female sex OR=1.44 [1.03 - 2.06], having attained tertiary education OR=1.91 [1.03 3.56], and older age OR=1.42 [1.27 - 1.59]). Conclusion: The prevalence of hypertension in this rural Ugandan district is relatively high. The findings confirm the growing concern about hypertension as a public health problem in Uganda. More studies are however required to determine the distribution and determinants of hypertension in other parts of the countryItem Religiosity for HIV prevention in Uganda: a case study among Christian youth in Wakiso district(African health sciences, 2012) Kagimu, M.; Guwatudde, D.; Rwabukwali, C.; Kaye, S.; Walakira, Y.; Ainomugisha, D.Utilization of religious institutions is one of the strategies for HIV prevention in Uganda. There is limited data on the association between religiosity and HIV infection rates. Objective: To determine the association between religiosity and HIV prevalence rates among Christians. Methods: An unmatched case-control study was done. Data from 106 HIV positive cases and 424 HIV negative controls between 15- 24 years were analyzed. Results: Lower religiosity was associated with higher HIV infection rates when the following dimensions were analyzed: feeling guided by God in daily activities (odds ratio 1.90, 95%CI 1.03-3.50, p=0.035), feeling thankful for God’s blessings (odds ratio 1.76, 95%CI 1.01-3.11, p=0.042), praying privately (odds ratio 2.02, 95%CI 1.30-3.11, p=0.001), trying hard to be patient in life (odds ratio1.74, 95%CI 1.07-2.84, p=0.024) and trying hard to love God (odds ratio 1.57, 95%CI 1.01-2.42, p=0.039). Higher HIV infection rates were associated with having multiple life-time sexual partners (odds ratio 5.37, 95%CI 1.86- 15.47, p<0.001), ever drinking alcohol (odds ratio 2.28, 95%CI 1.43-3.65, p<0.001) and ever using narcotics for recreation (odds ratio 2.49, 95%CI 1.14-5.44, p=0.018). Conclusion: Lower levels of several dimensions religiosity are significantly associated with higher HIV infection rates. This data supports strengthening religiosity in HIV prevention strategies.Item Religiosity for HIV prevention in Uganda: a case study among Muslim youth in Wakiso district(African Health Sciences, 2012) Kagimu, M.; Guwatudde, D.; Rwabukwali, C.; Kaye, S.; Walakira, Y.; Ainomugisha, D.Evidence for the association between religiosity and HIV infections is limited. Sujda, the hyper-pigmented spot on the forehead due to repeated prostration during prayers and fasting to worship, involving abstaining from food, drink and sex during daytime in Ramadhan and other specified days, are measures of religiosity among Muslims Objectives: To assess the association between religiosity and HIV infections. Methods: This was an unmatched case-control study with 29 HIV positive cases and 116 HIV negative controls, from 1224 Muslims, 15-24 years. Results: Respondents without Sujda had more HIV infections (odds ratio 2.90, 95% CI 1.07-7.86, p=0.029). Those with Sujda were more likely to abstain from sex (odds ratio 1.69, 95% CI 1.31-2.20, p<0.001) and be faithful in marriage (odds ratio 1.69, 95% CI 1.11-2.57, p=0.012). Respondents without Sujda were more likely to have ever taken alcohol before sex (odds ratio 5.00, 95% CI 1.39-17.95, p=0.006) and to have ever used narcotics (odds ratio 2.12, 95% CI, 1.11-4.05, p=0.019). Respondents who fasted less, had more HIV infections (odds ratio 2.46, 95% CI 1.07-5.67, p=0.028). Conclusion: Sujda and fasting were associated with lower HIV infections. Imams should use this information to intensify the Islamic approach to HIV prevention.Item Vitamin-D deficiency impairs CD4þT-cell count recovery rate in HIV-positive adults on highly active antiretroviral therapy: Q9 A longitudinal study(Clinical Nutrition, 2015) Ezeamama, A.E.; Guwatudde, D.; Wang, M.; Bagenda, D.; Kyeyune, R.; Sudfeld, C.; Manabe, Y.C.; Fawzi, W.W.We implemented a prospective study among human immunodeficiency virus (HIV)- positive adults to examine the association between vitamin-D deficiency (VDD) and insufficiency (VDI) vs sufficiency (VDS) and CD4þT-cell improvement over 18 months of highly active antiretroviral therapy (HAART). Methods: We used data from a randomized placebo-controlled micronutrient trial with 25-hydroxy vitamin-D (25(OH)D) measured at enrollment in 398 adults. CD4þT-cell count was measured repeatedly at months 0, 3, 6, 12 and 18. Linear mixed models quantified the vitamin-D-related differences in CD4þT-cell count and associated 99% confidence intervals at baseline and respective follow-up intervals. Results: At baseline 23%, 60% and 17% of participants were VDS, VDI and VDD, respectively. Absolute CD4þT- cell counts recovered during follow-up were persistently lower for baseline VDD and VDI relative to VDS participants. The greatest deficit in absolute CD4þT-cells recovered occurred in VDD vs VDS participants with estimates ranging from a minimum deficit of 26 cells/ml (99% CI: 77, 26) to a maximum deficit of 65 cells/ml (99% CI: 125, 5.5) during follow-up. This VDD-associated lower absolute CD4þT-cell gain was strongest among patients 35 years old or younger and among participants with a baseline body mass index of less than 25 kg/m2. Conclusions: VDD is associated with lower absolute CD4þT-cell count recovery in HIV-positive patients on HAART. Vitamin-D supplementation may improve CD4þT-cell recovery during HAART. However, future intervention studies are needed to definitively evaluate the effectiveness of this vitamin as an adjunct therapy during HAART.