Browsing by Author "Kayitale Mbonye, Martin"
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Item Disease diagnosis in primary care in Uganda(BMC Family Practice, 2014) Kayitale Mbonye, Martin; Burnett, Sarah M.; Colebunders, Robert; Naikoba, Sarah; Van Geertruyden, Jean-Pierre; Weaver, Marcia R.; Ronald, AllanThe overall burden of disease (BOD) especially for infectious diseases is higher in Sub-Saharan Africa than other regions of the world. Existing data collected through the Health Management Information System (HMIS) may not be optimal to measure BOD. The Infectious Diseases Capacity Building Evaluation (IDCAP) cooperated with the Ugandan Ministry of Health to improve the quality of HMIS data. We describe diagnoses with associated clinical assessments and laboratory investigations of outpatients attending primary care in Uganda. Methods: IDCAP supported HMIS data collection at 36 health center IVs in Uganda for five months (November 2009 to March 2010) prior to implementation of the IDCAP interventions. Descriptive analyses were performed on a cross-sectional dataset of 209,734 outpatient visits during this period. Results: Over 500 illnesses were diagnosed. Infectious diseases accounted for 76.3% of these and over 30% of visits resulted in multiple diagnoses. Malaria (48.3%), cough/cold (19.4%), and intestinal worms (6.6%) were the most frequently diagnosed illnesses. Body weight was recorded for 36.8% of patients and less than 10% had other clinical assessments recorded. Malaria smears (64.2%) and HIV tests (12.2%) accounted for the majority of 84,638 laboratory tests ordered. Fewer than 30% of patients for whom a laboratory investigation was available to confirm the clinical impression had the specific test performed. Conclusions: We observed a broad range of diagnoses, a high percentage of multiple diagnoses including true co-morbidities, and underutilization of laboratory support. This emphasizes the complexity of illnesses to be addressed by primary healthcare workers. An improved HMIS collecting timely, quality data is needed. This would adequately describe the burden of disease and processes of care at primary care level, enable appropriate national guidelines, programs and policies and improve accountability for the quality of care.Item Effect of Integrated Capacity-Building Interventions on Malaria Case Management by Health Professionals in Uganda: A Mixed Design Study with Pre/Post and Cluster Randomized Trial Components(PloS one, 2014) Kayitale Mbonye, Martin; Burnett, Sarah M.; Burua, Aldomoro; Colebunders, Robert; Crozier, Ian; Kinoti, Stephen N.; Ronald, Allan; Naikoba, Sarah; Rubashembusya, Timothy; Van geertruyden, Jean-Pierre; Willis, Kelly S.; Weaver, Marcia R.The Integrated Infectious Diseases Capacity Building Evaluation (IDCAP) designed two interventions: Integrated Management of Infectious Disease (IMID) training program and On-Site Support (OSS). We evaluated their effects on 23 facility performance indicators, including malaria case management. Methodology: IMID, a three-week training with two follow-up booster courses, was for two mid- level practitioners, primarily clinical officers and registered nurses, from 36 primary care facilities. OSS was two days of training and continuous quality improvement activities for nine months at 18 facilities, to which all health workers were invited to participate. Facilities were randomized as clusters 1:1 to parallel OSS ‘‘arm A’’ or control ‘‘arm B’’. Outpatient data on four malaria case management indicators were collected for 14 months. Analysis compared changes before and during the interventions within arms (relative risk = RR). The effect of OSS was measured with the difference in changes across arms (ratio of RR = RRR). Findings: The proportion of patients with suspected malaria for whom a diagnostic test result for malaria was recorded decreased in arm B (adjusted RR (aRR) = 0.97; 99%CI: 0.82,1.14) during IMID, but increased 25% in arm A (aRR = 1.25; 99%CI:0.94, 1.65) during IMID and OSS relative to baseline; (aRRR = 1.28; 99%CI:0.93, 1.78). The estimated proportion of patients that received an appropriate antimalarial among those prescribed any antimalarial increased in arm B (aRR = 1.09; 99%CI: 0.87, 1.36) and arm A (aRR = 1.50; 99%CI: 1.04, 2.17); (aRRR = 1.38; 99%CI: 0.89, 2.13). The proportion of patients with a negative diagnostic test result for malaria prescribed an antimalarial decreased in arm B (aRR = 0.96; 99%CI: 0.84, 1.10) and arm A (aRR = 0.67; 99%CI: 0.46, 0.97); (aRRR = 0.70; 99%CI: 0.48, 1.00). The proportion of patients with a positive diagnostic test result for malaria prescribed an antibiotic did not change significantly in either arm.Item Effectiveness of educational outreach in infectious diseases management: a cluster randomized trial in Uganda(BMC Public Health, 2016) Kayitale Mbonye, Martin; Burnett, Sarah M.; Naikoba, Sarah; Ronald, Allan; Colebunders, Robert; Van Geertruyden, Jean-Pierre; Weaver, Marcia R.Integrated Infectious Diseases Capacity Building Evaluation (IDCAP) teams designed and implemented two health worker in-service training approaches: 1) an off-site classroom-based integrated management of infectious diseases (IMID) course with distance learning aspects, and 2) on-site support (OSS), an educational outreach intervention. We tested the effects of OSS on workload and 12 facility performance indicators for emergency triage assessment and treatment, HIV testing, and malaria and pneumonia case management among outpatients by two subgroups: 1) mid-level practitioners (MLP) who attended IMID training (IMID-MLP) and 2) health workers who did not (No-IMID). Methods: Thirty-six health facilities participated in the IDCAP trial, with 18 randomly assigned to Arm A and 18 to Arm B. Two MLP in both arms received IMID. All providers at Arm A facilities received nine monthly OSS visits from April to December 2010 while Arm B did not. From November 2009 to December 2010, 777,667 outpatient visits occurred. We analyzed 669,580 (86.1 %) outpatient visits, where provider cadre was reported. Treatment was provided by 64 IMID-MLP and 1,515 No-IMID providers. The effect of OSS was measured by the difference in pre/post changes across arms after controlling for covariates (adjusted ratio of relative risks = aRRR). Results: The effect of OSS on patients-per-provider-per-day (workload) among IMID-MLP (aRRR = 1.21; p = 0.48) and No-IMID (aRRR = 0.90; p = 0.44) was not statistically significant. Among IMID-MLP, OSS was effective for three indicators: malaria cases receiving an appropriate antimalarial (aRRR = 1.26, 99 % CI = 1.02-1.56), patients with negative malaria test result prescribed an antimalarial (aRRR = 0.49, 99 % CI = 0.26-0.92), and patients with acid-fast bacilli smear negative result receiving empiric treatment for acute respiratory infection (aRRR = 2.04, 99 % CI = 1.06-3.94). Among No-IMID, OSS was effective for two indicators: emergency and priority patients admitted, detained or referred (aRRR = 2.12, 99 % CI = 1.05-4.28) and emergency patients receiving at least one appropriate treatment (aRRR = 1.98, 99 % CI = 1.21-3.24). Conclusion: Effects of OSS on workload were not statistically significant. Significant OSS effects on facility performance across subgroups were heterogeneous. OSS supported MLP who diagnosed and treated patients to apply IMID knowledge. For other providers, OSS supported team work to manage emergency patients. This evidence on OSS effectiveness could inform interventions to improve health workers’ capacity to deliver better quality infectious diseases care.Item Malaria Care in Infants Aged under Six Months in Uganda: An Area of Unmet Needs!(PLoS One, 2015) Kayitale Mbonye, Martin; Burnett, Sarah M.; Naikoba, Sarah; Colebunders, Robert; Wouters, Kristien; Weaver, Marcia R.; Van Geertruyden, Jean PierreLittle information exists on malaria burden, artemisinin-based combination therapy (ACT) use, and malaria care provided to infants under six months of age. The perception that malaria may be rare in this age group has led to lack of clinical trials and evidence-based treatment guidelines. The objective of this study was to identify malaria parasitemia positivity rate (MPPR) among patients under six months, and practices and predictors of malaria diagnosis and treatment in this population. Methods Cross-sectional data collected from October 2010 to September 2011 on 25,997 individual outpatients aged <6 months from 36 health facilities across Uganda were analysed. Findings Malaria was suspected in 18,415 (70.8%) patients, of whom 7,785 (42.3%) were tested for malaria. Of those tested, the MPPR was 36.1%, with 63.9%testing negative, of which 1,545 (31.1%) were prescribed an antimalarial. Among children <5kgs, off-label prescription of ACT was high (104/285, 36.5%). Younger age (1-6 days, aOR=0.47, p=0.01; 7-31 days, aOR=0.43, p<0.001; and 1-2 months, aOR=0.61, p<0.001), pneumonia (aOR=0.78, p=0.01) or cough/cold (aOR=0.65, p<0.001) diagnosis, and fever (aOR=0.56, p=0.01) reduced the odds of receiving a malaria test. Fever (aOR=2.22, p<0.001), anemia diagnosis (aOR=3.51, p=0.01), consulting midwives (aOR=3.58, p=0.04) and other less skilled providers (aOR=4.75, p<0.001) relative to medical officers, consulting at hospitals (aOR=3.31, p=0.03), visiting health facilities in a medium-high malaria transmission area (aOR=2.20, p<0.001), and visiting during antimalarial (aOR=1.82, p=0.04) or antibiotic (aOR=2.23, p=0.04) shortages increased the odds of prescribing an antimalarial despite a negative malaria test result. Conclusions We found high malaria suspicion but low testing rates in outpatient children aged <6 months. Among those tested, MPPR was high. Despite a negative malaria test result, many infants were prescribed antimalarials. Off-label ACT prescription was common in children weighing <5kgs. Evidence-based malaria guidelines for infants weighing <5 kilograms and aged <6 months are urgently needed.Item Parent–child communication on sexual and reproductive health in border districts of Eastern Uganda(Sex Education, 2022) Kisaakye, Peter; Ndugga, Patricia; Kwagala, Elizabeth; Kayitale Mbonye, Martin; Ngabirano, Fred; Ojiambo Wandera, StephenParent-child communication concerning sexual and reproductive health (SRH) has significant potential to reduce children’s risky sexual behaviour. Despite these benefits, few parents communicate with their children about SRH issues in Uganda. Using multistage stratified sampling in a cross-sectional survey, we estimated the prevalence and investigated the factors that were associated with recent parent-child communication among 600 children (10- 17 years) in border districts of Uganda (Busia and Tororo). Results indicated that 61% of children reported to having received parentchild communication on SRH. Communication was more likely to happen among children living in urban areas (OR=4.88; 95% CI=1.79-13.33), boys (OR=1.84; 95% CI=1.13-3.00), those aged 15- 19 years (OR=2.59; 95% CI=1.51-4.46) and among children from households that owned a mobile phone (OR=2.11; 95% CI=1.05- 4.21) than their counterparts. Parent-child communication was also higher among children who were comfortable discussing SRH issues (OR=27.12; 95% CI=16.02-45.89) and children from Tororo district (OR=2.34; 95% CI=1.36-4.01). The findings provide a rich understanding of the factors associated with Parent-child communication in the border districts of Uganda. These results provide a basis for policy enactment or revision regarding the encouragement of parent-child communication about SRH in Uganda.Item Predictors of cervical cancer screening uptake in two districts of Central Uganda(PLoS ONE, 2020) Isabirye, Alone; Kayitale Mbonye, Martin; Kwagala, BettyUganda’s cervical cancer age standardized incidence rate is four times the global estimate. Although Uganda’s ministry of health recommends screening for women aged 25–49 years, the screening remains low even in the most developed region (Central Uganda) of the country. This study examined the demographic, social, and economic predictors of cervical cancer screening in Central Uganda with the aim of informing targeted interventions to improve screening. The cross-sectional survey was conducted in Wakiso and Nakasongola districts in Central Uganda. A total of 845 women age 25–49 years participated in the study. Data were analyzed at bivariate and multivariate levels to examine the predictors of CC (cervical cancer) screening. Only 1 in 5 women (20.6%) had ever screened for cervical cancer. Our multivariate logistic regression model indicated that wealth index, source of information, and knowledge about CC and CC screening were significantly associated with cervical cancer screening. The odds of cervical cancer screening were higher among rich women compared with poor women [AOR = 1.93 (95%CI: 1.06–3.42), p = 0.031)], receiving information from health providers compared with radios [AOR = 4.14 (95%CI: 2.65–6.48), p<0.001, and being more knowledgeable compared with being less knowledgeable about CC and CC screening [AOR = 2.46 (95%CI: 1.49–3.37), p<0.001)]. Overall cervical cancer screening uptake in central Uganda was found to be low. The findings of the study indicate that women from a wealthy background, who had been sensitized by health workers and with high knowledge about CC and CC screening had higher odds of having ever screened compared with their counterparts. Efforts to increase uptake of screening must address disparities in access to resources and knowledge.Item Rural urban differential in Transactional sex among unmarried (Not in Union) Young Women (15-24 years) in Uganda(Research Square, 2020) Okotel, Vincent; Wamala, Robert; Kayitale Mbonye, MartinTransactional sex, a causal exchange of gifts, money and services for sex is practiced globally. Transactional sex is associated with risky sexual behaviors, unintended pregnancy, gender based violence and HIV infection. Proportionally in 2016, TS among young women not in union in Uganda was almost twice in rural areas (16.4%) compared to urban (8.9%) areas. Despite the negative consequences associated with transactional sex, no study in Sub-Saharan Africa Uganda inclusive has provided a detailed account of the contribution of the variations in characteristics and variations in effects of characteristics to the rural-urban gap in transactional sex among young women not in union. This study therefore provides a detailed account of the rural-urban gap in TS by variations in characteristics and variations in effects of characteristics of young women in Uganda. Methods: The study utilized data from UDHS 2016 comprising of 1,595 records of young women (15-24 years) not in union (not currently married or living with a man). Statistical analysis was done using a Non-linear Oaxaca’ Blinder Multivariate Decomposition of the logistic regression. Results: In the results, the overall gap in rural-urban transactional sex is significantly attributed to both variations in characteristics (30.7%) and variations in effects of characteristics (69.3%) of young women (p<0.05). Specifically, the rural-urban gap in transactional sex among young women in Uganda is attributed to variation in total children ever born (-15.2%), age at first sex (10.3%) and variation in effect of highest education (-1, 1014.1%) and HIV stigma (-84.3%). Conclusion: In order to reduce transactional sex especially among young women in rural residence, government and other development partners need to strengthen comprehensive sex-education programs aimed at creating positive attitudes towards HIV, train young women on viable economic activities together with providing them with educational opportunities aimed at delaying sex.