Browsing by Author "Mugahi, Richard"

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    Cost-effectiveness results comparing heat-stable carbetocin & other uterotonics in postpartum heamorrhage prevention in Uganda
    (Public Library of Science, 2025-04) Ononge, Sam;; Kakaire, Othman;; Mwembezi, Jostas ;; Nakatudde, Hadijah;; Mutumba, Robert;; Mugahi, Richard
    In Uganda, postpartum haemorrhage (PPH) is responsible for 34% of all institutional maternal deaths. Injectable oxytocin is the preferred uterotonic for prevention of PPH. However, in resource-limited settings, the effectiveness of oxytocin is sub-optimal due to efficacy, quality (cold chain storage requirements), and manufacturing standards (poor quality active pharmaceutical ingredients, lack of sterile manufacturing environment, and low-quality manufacturing processes). This study aimed to assess the cost-effectiveness of heat-stable carbetocin, a quality uterotonic newly recommended by WHO and Ugandan Ministry of Health, compared to standard uterotonics for the prevention of PPH in Uganda. A decision tree model was built to assess the cost-effectiveness of heat-stable carbetocin compared to the current standards of care – oxytocin, misoprostol or oxytocoin+misoprostol combination. The model was applied to a hypothetical annual cohort of birthing women eligible for PPH prevention in Uganda’s public health facilities. The evaluation considered direct costs and health outcomes using a public health perspective. The model inputs were obtained through literature review and, whenever referencable information was unavailable or incomplete, from key opinion leaders. Compared to oxytocin, administering heat-stable carbetocin to prevent PPH had a cascading favorable effect and was estimated to avert 57,536 PPH cases, 123 maternal deaths, and 4,203 disability-adjusted life years (DALYs). Heat-stable carbetocin is also cost-saving where the direct cost to the public healthcare system was lower by USD $1,058,353 (UGX 3,998,350,875). The benefits of heat-stable carbetocin were even greater when compared with misoprostol (averted 73,939 PPH events, 273 maternal deaths, and 8,716 DALYs, and lowered public healthcare system costs by USD $2,118,372 [UGX 8,002,996,052]). Heat-stable carbetocin for preventing PPH in Uganda has the potential to reduce PPH events, and subsequently maternal deaths, DALYs, and costs for the public healthcare system. Adopting heat-stable carbetocin will contribute towards achieving the country’s Sustainable Development Goal 3.1.
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    What Does your Partner Want? Using a Gender Equality Lens to Assess Partner Support and Involvement in Family Planning in Uganda
    (Research Square, 2022) Olapeju, Bolanle; Odeke, Paul; Nalukwago, Judith; Mugabe, Pallen; Bufumbo, Leonard; Kimbowa, Musa; Kayongo, Emmanuel; Naibere, Mabel; Nanyonga, Nanah; Mugahi, Richard; Bakyaita, Tabley; Kabanda, Richard
    While partner involvement in health-related decision-making is linked with positive health behaviors, a key gap in the literature exists on how this construct should be measured and the specific ways men and women in Uganda perceive partner support in the context of family planning. The USAID-funded Social and Behavior Change Activity (SBCA) in Uganda explored the differences in male versus female priorities in the decision-making considerations and preferred measures of partner support related to family planning in order to design contextually relevant solutions.
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    What price a welcome? Understanding structure agency in the delivery of respectful midwifery care in Uganda
    (Emerald, 2018-03-05) Ackers, Louise; Webster, Hannah; Mugahi, Richard; Namiiro, Rachel
    Purpose The purpose of this paper is to present the findings of research on mothers and midwives’ understanding of the concept of respectful care in the Ugandan public health settings. It focusses on one aspect of respect; namely communication that is perhaps least resource-dependent. The research found endemic levels of disrespect and tries to understand the reasons behind these organisational cultures and the role that governance could play in improving respect. Design/methodology/approach The study involved a combination of in-depth qualitative interviews with mothers and midwives together with focus groups with a cohort of midwives registered for a degree. Findings The findings highlight an alarming level of verbal abuse and poor communication that both deter women from attending public health facilities and, when they have to attend, reduces their willingness to disclose information about their health status. Respect is a major factor reducing the engagement of those women unable to afford private care, with health facilities in Uganda. Research limitations/implications Access to quality care provided by skilled birth attendants (midwives) is known to be the major factor preventing improvements in maternal mortality and morbidity in low income settings. Although communication lies at the agency end of the structure-agency continuum, important aspects of governance contribute to high levels of disrespect. Originality/value Whilst there is a lot of research on the concept of respectful care in high income settings applying this to the care environment in low resource settings is highly problematic. The findings presented here generate a more contextualised analysis generating important new insights which we hope will improve the quality of care in Uganda health facilities.