Browsing by Author "Kaawa-Mafigiri, David"

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    Challenges to Ebola preparedness during an ongoing outbreak: An analysis of borderland livelihoods and trust in Uganda
    (Public Library of Science, 2020-03-26) Schmidt-Sane, Megan M; Nielsen, Jannie O; Chikombero, Mandi; Lubowa, Douglas; Lwanga, Miriam; Gamusi, Jonathan; Kabanda, Richard; Kaawa-Mafigiri, David
    Ebola Virus Disease in the Democratic Republic of Congo (DRC) was declared a public health emergency of international concern on July 17, 2019. The first case to cross the border into Uganda in June 2019 demonstrates the importance of better understanding border dynamics in a context of Ebola. This paper adopts a political economy approach to contextualize epidemic response programs conducted in moderate- and high-risk border districts in Uganda, through a qualitative study with 287 participants. To that end, our aim was to describe the historical underpinnings of the borderlands context; the role of livelihood strategies in constraining risk avoidance decisions; and the dynamics of trust in authority figures, including health workers. This paper reports that border communities are highly connected, for a variety of social and economic reasons. These daily realities are in direct opposition to guidance to limit travel during an active Ebola epidemic. We argue that an ability to limit movement is constrained by the economic need to seek livelihood strategies wherever that may be. Moreover, border regions are populated by communities with long-standing distrust in authority figures, particularly in fishing areas. This distrust spills over with consequences for Ebola prevention and control activities. This research indexes the importance of tailoring Ebola programming and policies to consider the political and economic dynamics of borderlands.
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    Changing from the “Pull” to the “Push” System of Distributing Essential Medicines and Health Supplies in Uganda: Implications for Efficient Allocation of Medicines and Meeting the Localized Needs of Health Facilities
    (Global Health Governance, 2013) Bukuluki, Paul; Byansi, Peter K.; Sengendo, John; Ddumba, Nyanzi I.; Banoba, Paul; Kaawa-Mafigiri, David
    Uganda has undergone several reforms in governance of the health sector. One of the profound reforms has been the radical shift in management of medicines from the “pull” approach—health facility staff participated in determining the medicines needed, to the “push” approach—the distribution of a standardized kit of essential medicine to health facilities irrespective of the disease burden and patient population. This paper is based on multi-site, mixed method cross-sectional study on governance in the health sector commissioned by Transparency International. It revealed that this shift affected delivery of essential medicines for rural and hard-to-reach frontline health facilities. Although there were indications that centralization had minimized inefficiency due to over invoicing, abuse of medicine funds and re-allocating funds meant for medicines to other recurrent items, it led to the supplying of large quantities of medicines that are not aligned to the disease burden and needs of some health facilities.
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    Effectiveness of a mobile antiretroviral pharmacy and HIV care intervention on the continuum of HIV care in rural Uganda
    (AIDS care, 2020) Bajunirwe, Francis; Ayebazibwe, Nicholas; Mulogo, Edgar; Eng, Maria; McGrath, Janet; Kaawa-Mafigiri, David; Mugyenyi, Peter; Sethi, Ajay K.
    Adherence to antiretroviral therapy (ART) is critical in order to achieve viral suppression. We designed an intervention, Mobile Antiretroviral Therapy and HIV care (MAP-HC) in rural southwestern Uganda aimed to reduce travel distance and hypothesized that MAP-HC would improve ART adherence and rates of viral load suppression. The study was conducted at two district hospitals, among patients who lived >5 km from the hospital. For each hospital, we identified 4 health centers in the catchment area to serve as site for the mobile pharmacy. Each site was visited once a month to provide ART refills and adherence counseling. We measured patient waiting time, adherence and viral load suppression before and after the intervention. The proportion of patients who missed an ART dose in the last 30 days dropped from 20% to 8.5% at 12 months post-intervention (p = 0.009) and those with detectable viral load dropped from 19.9% to 7.4% (p = 0.001), however, mean waiting time increased from 4.48 to 4.76 h (p = 0.13). Mobile pharmacy intervention in rural Uganda is feasible and resulted in improvement in adherence and viral load suppression. Although it did not reduce patient waiting time at the clinic, we recommend scale-up in rural areas where patients face transportation challenges.
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    Experiences and practices of key research team members in obtaining informed consent for pharmacogenetic research among people living with HIV: a qualitative study
    (Research Ethics, 2022) Ochieng, Joseph; Kaawa-Mafigiri, David; Munabi, Ian; Nakigudde, Janet; Nabukenya, Sylvia; Nakwagala, Frederick N.; Barugahare, John; Kwagala, Betty; Ibingira, Charles; Twimwijukye, Adelline; Sewankambo, Nelson; Mwaka Sabakaki, Erisa
    This study aimed to explore experiences and practices of key research team members in obtaining informed consent for pharmacogenetics research and to identify the approaches used for enhancing understanding during the consenting process. Data collection involved 15 qualitative, in-depth interviews with key researchers who were involved in obtaining informed consent from HIV infected individuals in Uganda for participation in pharmacogenetic clinical trials. The study explored two prominent themes: approaches used to convey information and enhance research participants’ understanding and challenges faced during the consenting process. Several barriers and facilitators for obtaining consent were identified. Innovative and potentially effective consenting strategies were identified in this study that should be studied and independently verified.
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    The first mile: community experience of outbreak control during an Ebola outbreak in Luwero District, Uganda
    (BMC public health, 2016) de Vries, Daniel H.; Rwemisisi, Jude T.; Musinguzi, Laban K.; Turinawe, Benoni E.; Muhangi, Denis; de Groot, Marije; Kaawa-Mafigiri, David; Pool, Robert
    A major challenge to outbreak control lies in early detection of viral haemorrhagic fevers (VHFs) in local community contexts during the critical initial stages of an epidemic, when risk of spreading is its highest (“the first mile”). In this paper we document how a major Ebola outbreak control effort in central Uganda in 2012 was experienced from the perspective of the community. We ask to what extent thecommunity became a resource for early detection, and identify problems encountered with community health worker and social mobilization strategies. Methods: Analysis is based on first-hand ethnographic data from the center of a small Ebola outbreak in Luwero Country, Uganda, in 2012. Three of this paper’s authors were engaged in an 18 month period of fieldwork on community health resources when the outbreak occurred. In total, 13 respondents from the outbreak site were interviewed, along with 21 key informants and 61 focus group respondents from nearby Kaguugo Parish. All informants were chosen through non-probability sampling sampling. Results: Our data illustrate the lack of credibility, from an emic perspective, of biomedical explanations which ignore local understandings. These explanations were undermined by an insensitivity to local culture, a mismatch between information circulated and the local interpretative framework, and the inability of the emergency response team to take the time needed to listen and empathize with community needs. Stigmatization of the local community – in particular its belief in amayembe spirits – fuelled historical distrust of the external health system and engendered community-level resistance to early detection. Conclusions: Given the available anthropological knowledge of a previous outbreak in Northern Uganda, it is surprising that so little serious effort was made this time round to take local sensibilities and culture into account. The “first mile” problem is not only a question of using local resources for early detection, but also of making use of the contextual cultural knowledge that has already been collected and is readily available. Despite remarkable technological innovations, outbreak control remains contingent upon human interaction and openness to cultural difference.
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    Nodding Syndrome in Post Conflict Northern Uganda: A Human Security Perspective
    (Global Health Governance, 2012) Bukuluki, Paul; Ddumba-Nyanzi, Ismail; David Kisuule, John; Ovuga, Emilio; Lien, Lars; Kaawa-Mafigiri, David
    An increasing concern of public health is the relationship between health and human security in conflict and post-conflict settings.1 Environments where conflicts have taken place are associated with the breakdown of public health infrastructure, massive displacement of people and disruption of livelihoods.2,3,4 Thus the processes and outcomes of violent conflict have implications for health and well-being, including recovery processes in post-conflict settings. Violent conflict is also closely related to “structural violence”, which broadly includes “violence of poverty, social and political marginalization, and other forms of structured inequalities and their effects on people’s lives, health and agency.”5 This underscores the need to understand how the health and wellbeing of people in post-conflict settings is influenced by violent conflict, antecedents to the conflict, or the complex intersection of both.6 This complex relationship raises questions about the challenges of ensuring human security in post-conflict settings especially in developing countries where public service delivery systems, including health and health care delivery, are already constrained.
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    Training Needs for Emerging Infectious Diseases Research, Surveillance and Control in High-Risk and Resource-Constrained Settings: Findings and Recommendations for Uganda
    (ResearchSquare, 2022) Asingura, Bannet; Kiweewa, Francis; Kaawa-Mafigiri, David; Achabo, Sheila; Mimbe, Derrick; Okullo, Allen Eva; Eyu, Patricia; Nanyondo, Jauhara; Naluyima, Prossy; Kandole, Martha; Tindikahwa, Allan; Nalunga, Justine; Ssekitoleko, Mathias; Nakakeeto, Josephine; Nawatti, Jesca; Kibirige, Daniel; Nansalire, Winfred
    Uganda is prone to Emerging Infectious Diseases (EIDs) which can cause serious epidemics and pandemics. Uganda’s capacity for EID research, surveillance and control is improving but still low partly due to inadequate highly knowledgeable and skilled human and animal health workers. To inform the design of training programs that can address Uganda’s health workforce capacity gaps, we conducted a training needs assessment.A qualitative study involving a desk review, 25 key informant interviews and a 1-day consultative workshop to review study findings.The majority of infectious disease research, surveillance and control in Uganda focuses on HIV/AIDS, Tuberculosis, Malaria and viral hemorrhagic fevers e.g., Ebola and Marburg. Health workforce capacity for surveillance and control is robust compared to many other resource-constrained settings but research capacity and output are relatively low, especially for EIDs. Public and private tertiary institutions in Uganda predominantly offer training in primary health care and population studies through problem-based learning, community-based education and services, and Blended Learning (BL). There are several training programs in advanced clinical and epidemiological sciences, but few opportunities in biomedical sciences (e.g. virology, immunology, bioinformatics and predictive modeling), social sciences, One Health and leadership. To address the gaps, the following interventions were recommended: 1) advanced graduate and/or post-graduate training in basic biomedical sciences; 2) short-term training for continuous knowledge and skills development in multidisciplinary/One Health approaches; and 3) pedagogy and mentorship through BL, networking and experiential training programs that effectively leverage North-South collaborations. Training and mentorship should be achieved by (a) conducting most of the in-person didactic and experiential training at Southern tertiary and research institutions, (b) utilizing electronic-learning for didactic training and mentor-mentee interactions with subject-matter experts at Northern institutions, and (c) well-orchestrated placements at Northern institutions for hands-on experience using the latest advances in science and technology.Inadequate health workforce capacity for EID research was identified as a priority gap that requires long and short-term multidisciplinary training interventions. Efficiently leveraging North-South collaborations for e-learning, short-term placements and mentorship will enable Uganda to remain abreast with latest advances in science and technology for EID research, surveillance and control.