Browsing by Author "Mafigiri, David K."
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Item Impact of stigma on HIV treatment seeking behavior among the youth living with HIV and AIDS in sub-Saharan Africa: critical review of literature(International Journal of HIV-Related Problems, 2021) Kiwanuka, Anthony; Walakira, Eddy; Andersson, Lena; Mafigiri, David K.An estimated 11.8 million youths in sub-Saharan Africa are living with HIV and AIDS, and more than one-half of those newly infected with HIV today are between 18 and 24 years. This study reviewed research assessing the impact of stigma on HIV treatment seeking behavior among youths in sub-Saharan Africa. The review highlighted particular stigma issues that young people face. Also, it analyzed the causes and consequences of stigma, and identified skills to cope with stigma and to build modalities for a change of behavior. The review include original articles published between 1988 and 2019 on HIV and AIDS stigma, which were found on various internet sites. The review determined that in developing countries, social and economic factors have an impact on HIV infection, including mainly older grandparents and their role as caregivers of orphaned children as a result of parental HIV infection. Therefore, there is a need to incorporate culturally sensitive modalities that assure target populations’ ability to respond to local understandings of key issues associated with HIV and AIDS stigmatization. Stigma among the youth remains a barrier to all essential components, which constitute a good prevention program, and much detailed research on stigma reduction is required to improve components of a good prevention program. Health education campaigns should integrate a change from fear to care for people living with HIV/AIDS, especially among healthcare personnel. More prevention activities should be situated in rural and remote areas of each country than in urban locations, as currently in Nigeria. Since most of the population resides in rural areas, it is most appropriate to concentrate these programs in such locations.Item Learning health professionalism at Makerere University: an exploratory study amongst undergraduate students(BMC medical education, 2010) Baingana, Rhona K.; Nakasujja, Noeline; Galukande, Moses; Omona, Kenneth; Mafigiri, David K.; Sewankambo, Nelson K.Anecdotal evidence shows that unprofessional conduct is becoming a common occurrence amongst health workers in Uganda. The development of appropriate professional values, attitudes and behaviors is a continuum that starts when a student joins a health professional training institution and as such health professionals in training need to be exposed to the essence of professionalism. We sought to explore undergraduate health professions students’ perceptions and experiences of learning professionalism as a preliminary step in addressing the problem of unprofessional conduct amongst health workers in Uganda. Methods: Eight focus group discussions were conducted with 49 first to fifth year health professions undergraduate students of the 2008/2009 academic year at Makerere University College of Health Sciences. The focus group discussions were recorded and transcribed, and were analyzed using content analysis with emergent coding. Results: The difference in the way first and fifth year students of Makerere University College of Health Sciences conceptualized professionalism was suggestive of the decline in attitude that occurs during medical education. The formal curriculum was described as being inadequate while the hidden and informal curricula were found to play a critical role in learning professionalism. Students identified role models as being essential to the development of professionalism and emphasized the need for appropriate role modeling. In our setting, resource constraints present an important, additional challenge to learning universal standards of health professionalism. Furthermore, students described practices that reflect the cultural concept of communalism, which conflicts with the universally accepted standard of individual medical confidentiality. The students questioned the universal applicability of internationally accepted standards of professionalism.Item Level of understanding of co-trimoxazole use among HIV infected, recurrent pulmonary tuberculosis suspects at a national referral tuberculosis clinic in Kampala, Uganda: a qualitative analysis.(African Health Sciences, 2015) Okwera, Alphonse; Mafigiri, David K.; Guwatudde, David; Whalen, Christopher; Joloba, MosesCo-trimoxazole use is the standard of care for preventing Pneumocystis jirovecii pneumonia in sub-Saharan Africa but implementation remains slow. Co-trimoxazole is self- administered with uncertain adherence. Knowledge of co-trimoxazole use among HIV infected persons is unknown. Objectives: To assess knowledge, attitudes and practices of co-trimoxazole use among HIV infected adults evaluated for recurrent PTB in Kampala, Uganda. Methods: A qualitative study utilizing 5 focus group discussions among 30 HIV infected PTB suspects at the national referral tuberculosis treatment centre in Kampala. Results: Males and females had similar median ages. 80% were currently on co-trimoxazole and 50% of participants were on HAART. Majority of participants defined co-trimoxazole as an analgesic. Few noted co-trimoxazole was a drug to treat cough and chest pain. However, few responses revealed that co-trimoxazole prevents opportunistic diseases among PLHIV. Most of participants believed HAART and anti-TB drugs work as co-trimoxazole thus it should not be taken together with them. This belief may lead to increased risk of opportunistic infections, morbidity and mortality. Conclusions: We revealed gaps in understanding of co-trimoxazole use among study participants. We therefore recommend that more facts about co-trimoxazle as prophylaxis against P. jirovecii, bacterial and diarrheal pathogens should be incorporated in VCT fact sheets.Item Linking Communities to Formal Health Care Providers through Village Health Teams in Rural Uganda: Lessons from Linking Social Capital(Human resources for health, 2017) Musinguzi, Laban Kashaija; Turinawe, Emmanueil Benon; Rwemisisi, Jude T.; Vries, Daniel H. de; Mafigiri, David K.; Muhangi, Denis; Groot, Marije de; Katamba, Achilles; Pool, RobertCommunity-based programmes, particularly community health workers (CHWs), have been portrayed as a cost-effective alternative to the shortage of health workers in low-income countries. Usually, literature emphasises how easily CHWs link and connect communities to formal health care services. There is little evidence in Uganda to support or dispute such claims. Drawing from linking social capital framework, this paper examines the claim that village health teams (VHTs), as an example of CHWs, link and connect communities with formal health care services.Data were collected through ethnographic fieldwork undertaken as part of a larger research program in Luwero District, Uganda, between 2012 and 2014. The main methods of data collection were participant observation in events organised by VHTs. In addition, a total of 91 in-depth interviews and 42 focus group discussions (FGD) were conducted with adult community members as part of the larger project. After preliminary analysis of the data, we conducted an additional six in-depth interviews and three FGD with VHTs and four FGD with community members on the role of VHTs. Key informant interviews were conducted with local government staff, health workers, local leaders, and NGO staff with health programs in Luwero. Thematic analysis was used during data analysis.The ability of VHTs to link communities with formal health care was affected by the stakeholders’ perception of their roles. Community members perceive VHTs as working for and under instructions of “others”, which makes them powerless in the formal health care system. One of the challenges associated with VHTs’ linking roles is support from the government and formal health care providers. Formal health care providers perceived VHTs as interested in special recognition for their services yet they are not “experts”. For some health workers, the introduction of VHTs is seen as a ploy by the government to control people and hide its inability to provide health services. Having received training and initial support from an NGO, VHTs suffered transition failure from NGO to the formal public health care structure. As a result, VHTs are entangled in power relations that affect their role of linking community members with formal health care services. We also found that factors such as lack of money for treatment, poor transport networks, the attitudes of health workers and the existence of multiple health care systems, all factors that hinder access to formal health care, cannot be addressed by the VHTs.As linking social capital framework shows, for VHTs to effectively act as links between the community and formal health care and harness the resources that exist in institutions beyond the community, it is important to take into account the power relationships embedded in vertical relationships and forge a partnership between public health providers and the communities they serve. This will ensure strengthened partnerships and the improved capacity of local people to leverage resources embedded in vertical power networks.Item Perspectives on the role of stakeholders in knowledge translation in health policy development in Uganda(BMC Health Services Research, 2013) Nabyonga Orem, Juliet; Marchal, Bruno; Mafigiri, David K.; Ssengooba, Freddie; Macq, Jean; da Silveira, Valeria C.; Criel, BartStakeholder roles in the application of evidence are influenced by context, the nature of the evidence, the policy development process, and stakeholder interactions. Past research has highlighted the role of stakeholders in knowledge translation (KT) without paying adequate attention to the peculiarities of low-income countries. Here we identify the roles, relations, and interactions among the key stakeholders involved in KT in Uganda and the challenges that they face. Methods: This study employed qualitative approaches to examine the roles of and links among various stakeholders in KT. In-depth interviews were conducted with 21 key informants and focused on the key actors in KT, their perceived roles, and challenges. Results: Major stakeholders included civil society organizations with perceived roles of advocacy, community mobilization, and implementation. These stakeholders may ignore unconvincing evidence. The community’s role was perceived as advocacy and participation in setting research priorities. The key role of the media was perceived as knowledge dissemination, but respondents noted that the media may misrepresent evidence if it is received in a poorly packaged form. The perceived roles of policy makers were evidence uptake, establishing platforms for KT and stewardship; negative roles included ignoring or even misrepresenting evidence that is not in their favor. The roles of parliamentarians were perceived as advocacy and community mobilization, but they were noted to pursue objectives that may not be supported by the evidence. The researchers’ main role was defined as evidence generation, but focusing disproportionately on academic interests was cited as a concern. The donors’ main role was defined as funding research and KT, but respondents were concerned about the local relevance of donor-supported research. Respondents reported that links among stakeholders were weak due to the absence of institutionalized, inclusive platforms. Challenges facing the stakeholders in the process of KT were identified.Item Research, evidence and policymaking: the perspectives of policy actors on improving uptake of evidence in health policy development and implementation in Uganda(BMC Public Health, 2012) Nabyonga Orem, Juliet; Mafigiri, David K.; Marchal, Bruno; Ssengooba, Freddie; Macq, Jean; Criel, BartUse of evidence in health policymaking plays an important role, especially in resource-constrained settings where informed decisions on resource allocation are paramount. Several knowledge translation (KT) models have been developed, but few have been applied to health policymaking in low income countries. If KT models are expected to explain evidence uptake and implementation, or lack of it, they must be contextualized and take into account the specificity of low income countries for example, the strong influence of donors. The main objective of this research is to elaborate a Middle Range Theory (MRT) of KT in Uganda that can also serve as a reference for other low- and middle income countries. Methods: This two-step study employed qualitative approaches to examine the principal barriers and facilitating factors to KT. Step 1 involved a literature review and identification of common themes. The results informed the development of the initial MRT, which details the facilitating factors and barriers to KT at the different stages of research and policy development. In Step 2, these were further refined through key informant interviews with policymakers and researchers in Uganda. Deductive content and thematic analysis was carried out to assess the degree of convergence with the elements of the initial MRT and to identify other emerging issues. Results: Review of the literature revealed that the most common emerging facilitating factors could be grouped under institutional strengthening for KT, research characteristics, dissemination, partnerships and political context. The analysis of interviews, however, showed that policymakers and researchers ranked institutional strengthening for KT, research characteristics and partnerships as the most important. New factors emphasized by respondents were the use of mainstreamed structures within MoH to coordinate and disseminate research, the separation of roles between researchers and policymakers, and the role of the community and civil society in KT.Item Selection and Performance of Village Health Teams (VHTS) in Uganda: Lessons from the Natural Helper Model of Health Promotion(Human resources for health, 2015) Turinawe, Emmanueil Benon; Rwemisisi, Jude T.; Musinguzi, Laban K.; Groot, Marije de; Muhangi, Denis; Vries, Daniel H. de; Mafigiri, David K.; Pool, RobertCommunity health worker (CHW) programmes have received much attention since the 1978 Declaration of Alma-Ata, with many initiatives established in developing countries. However, CHW programmes often suffer high attrition once the initial enthusiasm of volunteers wanes. In 2002, Uganda began implementing a national CHW programme called the village health teams (VHTs), but their performance has been poor in many communities. It is argued that poor community involvement in the selection of the CHWs affects their embeddedness in communities and success. The question of how selection can be implemented creatively to sustain CHW programmes has not been sufficiently explored. In this paper, our aim was to examine the process of the introduction of the VHT strategy in one rural community, including the selection of VHT members and how these processes may have influenced their work in relation to the ideals of the natural helper model of health promotion.As part of a broader research project, an ethnographic study was carried out in Luwero district. Data collection involved participant observation, 12 focus group discussions (FGDs), 14 in-depth interviews with community members and members of the VHTs and four key informant interviews. Interviews and FGD were recorded, transcribed and coded in NVivo. Emerging themes were further explored and developed using text query searches. Interpretations were confirmed by comparison with findings of other team members.The VHT selection process created distrust, damaging the programme’s legitimacy. While the Luwero community initially had high expectations of the programme, local leaders selected VHTs in a way that sidelined the majority of the community’s members. Community members questioned the credentials of those who were selected, not seeing the VHTs as those to whom they would go to for help and support. Resentment grew, and as a result, the ways in which the VHTs operated alienated them further from the community. Without the support of the community, the VHTs soon lost morale and stopped their work.As the natural helper model recommends, in order for CHW programmes to gain and maintain community support, it is necessary to utilize naturally existing informal helping networks by drawing on volunteers already trusted by the people being served. That way, the community will be more inclined to trust the advice of volunteers and offer them support in return, increasing the likelihood of the sustainability of their service in the community.Item Towards Promotion of Community rewards to Volunteer Community Health Workers? Lessons from Experiences of Village Health Teams in Luwero, Uganda(Res Health Sci,, 2016) Turinawe, Emmanueil Benon; Rwemisisi, Jude T.; Musinguzi, Laban K.; Groot, Marije de; Muhangi, Denis; Mafigiri, David K.; Vries, Daniel H. de; Pool, RobertIn the debate regarding volunteer Community Health Workers (CHWs) some argue that lack of remuneration is exploitation while others caution that any promise to pay volunteers will decrease the volunteer spirit. In this paper we discuss the possibility of community rewards for CHWs. Ethnographic fieldwork that lasted 18 months utilised methods including participant observation, FGDs, in-depth interviews and key informant interviews to gain insight into the dynamic relationship between volunteer CHWs known as Village Health Teams (VHTs) and the community. Contextual transcription was done and data was thematically analysed. Findings show that community members are willing to reward volunteer CHWs with cash, material and symbolic rewards in appreciation for their help. Factors crucial for this gesture included: care and recognition of the VHTs’ work by medical staff, fulfilment of the promises made to the community by government and exemplary behaviour by CHWs. Therefore, effort should be made to facilitate volunteer CHWs to be seen as helpful to their communities. Especially, there needs to be a smooth operation at the intersection between the VHTs, local government and medical structures. Community rewards could be a more sustainable way of motivating CHWs while a solution to health personnel shortage is sought.Item Traditional Birth Attendants (TBAS) as Potential Agents in Promoting Male Involvement in Maternity Preparedness: Insights from a Rural Community in Uganda(Reproductive health, 2016) Turinawe, Emmanueil Benon; Rwemisisi, Jude T.; Musinguzi, Laban K.; Groot, Marije de; Muhangi, Denis; Vries, Daniel H. de; Mafigiri, David K.; Katamba, Achilles; Parker, Nadine; Pool, RobertSince the 1994 International Conference on Population and Development, male involvement in reproductive health issues has been advocated as a means to improve maternal and child health outcomes, but to date, health providers have failed to achieve successful male involvement in pregnancy care especially in rural and remote areas where majority of the underserved populations live. In an effort to enhance community participation in maternity care, TBAs were trained and equipped to ensure better care and quick referral. In 1997, after the advent of the World Health Organization’s Safe Motherhood initiative, the enthusiasm turned away from traditional birth attendants (TBAs). However, in many developing countries, and especially in rural areas, TBAs continue to play a significant role. This study explored the interaction between men and TBAs in shaping maternal healthcare in a rural Ugandan context.This study employed ethnographic methods including participant observation, which took place in the process of everyday life activities of the respondents within the community; 12 focus group discussions, and 12 in-depth interviews with community members and key informants. Participants in this study were purposively selected to include TBAs, men, opinion leaders like village chairmen, and other key informants who had knowledge about the configuration of maternity services in the community. Data analysis was done inductively through an iterative process in which transcribed data was read to identify themes and codes were assigned to those themes.Contrary to the thinking that TBA services are utilized by women only, we found that men actively seek the services of TBAs and utilize them for their wives’ healthcare within the community. TBAs in turn sensitize men using both cultural and biomedical health knowledge, and become allies with women in influencing men to provide resources needed for maternity care.In this study area, men trust and have confidence in TBAs; closer collaboration with TBAs may provide a suitable platform through which communities can be sensitized and men actively brought on board in promoting maternal health services for women in rural communities.