Browsing by Author "Mubiru, Denis"

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    Integrated community case management in a peri-urban setting: a qualitative evaluation in Wakiso District, Uganda
    (BMC health services research, 2017) Altaras, Robin; Montague, Mark; Graham, Kirstie; Strachan, Clare E.; Senyonjo, Laura; King, Rebecca; Counihan, Helen; Mubiru, Denis; Källander, Karin; Meek, Sylvia; Tibenderana, James
    Integrated community case management (iCCM) strategies aim to reach poor communities by providing timely access to treatment for malaria, pneumonia and diarrhoea for children under 5 years of age. Community health workers, known as Village Health Teams (VHTs) in Uganda, have been shown to be effective in hard-to-reach, underserved areas, but there is little evidence to support iCCM as an appropriate strategy in non-rural contexts. This study aimed to inform future iCCM implementation by exploring caregiver and VHT member perceptions of the value and effectiveness of iCCM in peri-urban settings in Uganda. Methods: A qualitative evaluation was conducted in seven villages in Wakiso district, a rapidly urbanising area in central Uganda. Villages were purposively selected, spanning a range of peri-urban settlements experiencing rapid population change. In each village, rapid appraisal activities were undertaken separately with purposively selected caregivers (n = 85) and all iCCM-trained VHT members (n = 14), providing platforms for group discussions. Fifteen key informant interviews were also conducted with community leaders and VHT members. Thematic analysis was based on the ‘Health Access Livelihoods Framework’. Results: iCCM was perceived to facilitate timely treatment access and improve child health in peri-urban settings, often supplanting private clinics and traditional healers as first point of care. Relative to other health service providers, caregivers valued VHTs’ free, proximal services, caring attitudes, perceived treatment quality, perceived competency and protocol use, and follow-up and referral services. VHT effectiveness was perceived to be restricted by inadequate diagnostics, limited newborn care, drug stockouts and VHT member absence – factors which drove utilisation of alternative providers. Low community engagement in VHT selection, lack of referral transport and poor availability of referral services also diminished perceived effectiveness. The iCCM strategy was widely perceived to result in economic savings and other livelihood benefits. Conclusions: In peri-urban areas, iCCM was perceived as an effective, well-utilised strategy, reflecting both VHT attributes and gaps in existing health services. Depending on health system resources and organisation, iCCM may be a useful transitional service delivery approach. Implementation in peri-urban areas should consider tailored community engagement strategies, adapted selection criteria, and assessment of population density to ensure sufficient coverage.
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    Shifts in Geographic Distribution and Antimicrobial Resistance during a Prolonged Typhoid Fever Outbreak — Bundibugyo and Kasese Districts, Uganda, 2009–2011
    (PLoS Negl Trop Dis, 2014) Spalding Walters, Maroya; Routh, Janell; Mikoleit, Matthew; Kadivane, Samuel; Ouma, Caroline; Mubiru, Denis; Mbusa, Ben; Murangi, Amos; Ejoku, Emmanuel; Rwantangle, Absalom; Kule, , Uziah; Lule, John; Garrett, Nancy; Halpin, Jessica; Maxwell, Nikki; Kagirita, Atek; Mulabya, Fred; Makumbi, Issa; Freeman, Molly; Joyce, Kevin; Hill, Vince; Downing, Robert; Mintz, Eric
    Salmonella enterica serovar Typhi is transmitted by fecally contaminated food and water and causes approximately 22 million typhoid fever infections worldwide each year. Most cases occur in developing countries, where approximately 4% of patients develop intestinal perforation (IP). In Kasese District, Uganda, a typhoid fever outbreak notable for a high IP rate began in 2008. We report that this outbreak continued through 2011, when it spread to the neighboring district of Bundibugyo. Methodology/Principal Findings: A suspected typhoid fever case was defined as IP or symptoms of fever, abdominal pain, and $1 of the following: gastrointestinal disruptions, body weakness, joint pain, headache, clinically suspected IP, or nonresponsiveness to antimalarial medications. Cases were identified retrospectively via medical record reviews and prospectively through laboratory-enhanced case finding. Among Kasese residents, 709 cases were identified from August 1, 2009–December 31, 2011; of these, 149 were identified during the prospective period beginning November 1, 2011. Among Bundibugyo residents, 333 cases were identified from January 1–December 31, 2011, including 128 cases identified during the prospective period beginning October 28, 2011. IP was reported for 507 (82%) and 59 (20%) of Kasese and Bundibugyo cases, respectively. Blood and stool cultures performed for 154 patients during the prospective period yielded isolates from 24 (16%) patients. Three pulsed-field gel electrophoresis pattern combinations, including one observed in a Kasese isolate in 2009, were shared among Kasese and Bundibugyo isolates. Antimicrobial susceptibility was assessed for 18 isolates; among these 15 (83%) were multidrug-resistant (MDR), compared to 5% of 2009 isolates. Conclusions/Significance: Molecular and epidemiological evidence suggest that during a prolonged outbreak, typhoid spread from Kasese to Bundibugyo. MDR strains became prevalent. Lasting interventions, such as typhoid vaccination and improvements in drinking water infrastructure, should be considered to minimize the risk of prolonged outbreaks in the future.
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    Usability of a digital tool to support long‑lasting insecticide net distribution in Northern Bahr el Ghazal State, South Sudan
    (Malaria Journal, 2024) Khan, Jamshed; Mubiru, Denis; Chestnutt, Elisabeth G.; Cook, Louise; Riiny, Lual L.; Okot, Francis; Chong, Kediende; Tieng, Matur T.; Zabbeh, Tombari; Okafor, Joshua; Nnaji, Chuks A.
    Long-lasting insecticidal nets (LLINs) have been a widely used malaria prevention method for decades. In South Sudan, LLINs are typically distributed by volunteers who use paper-based systems to collect distribution data. Paper-based systems are simple to use but have a higher occurrence of data inaccuracies and can hinder the timely use of data for decision-making. In 2022, a digital tool was introduced to collect data during the LLIN campaign in Northern Bahr el Ghazal (NBeG). The tool aimed to improve the accuracy of data entry and enable data to be used in real-time for decision making during the campaign. The digital tool was developed with offline functionality and interoperability with DHIS2 tracker version 2.8 in DHIS2 version 2.38. This study assessed the usability of the tool according to user perspectives. Methods A questionnaire containing open- and closed-ended questions was conducted with users of the digital tool, supervisors and other key stakeholders in five counties of NBeG. The questionnaire was administered using Malaria Consortium’s Projects Results System Android mobile application. Usability was determined through a modified and validated System Usability Scale (SUS) approach. Results A total of 93 participants responded to the usability questionnaire. The mean (± standard deviation) usability score across 10 SUS-scoring items was 60.91 (12.87), indicating a modest level of usability. The majority of users agreed the tool was useful for managing the LLIN distribution workflow, was easy to use, reduced workload, and supported stock management and real-time campaign monitoring. There was no significant difference in the usability scores across genders, roles, and counties. Respondents with experience of both paper-based and the digital tool tended to express a preference for the digital tool over paper-based systems. The majority of respondents also reported they would recommend the digital tool to colleagues. Conclusion Digital tools are perceived to improve data collection during LLIN campaigns, even in remote areas where network coverage is challenging. Additional improvements can be implemented to overcome operational challenges and improve usability of the tool. Further study is needed to assess the impact of the digital tool on data quality and real-time data use.