Browsing by Author "Mulogo, Edgar Mugema"

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    A Cross-Sectional Study Comparing Case Scenarios and Record Review to Measure Quality of Integrated Community Case Management Care in Western Uganda
    (Transactions of the Royal Society of Tropical Medicine and Hygiene, 2021) Miller, James S.; Mbusa, Rapheal Kisolhu; Baguma, Stephen; Patel, Palka; Matte, Michael; Ntaro, Moses; Wesuta, Andrew Christopher; Mumbere, Nobert; Bwambale, Shem; McCarthy, Sara Mian; Kenney, Jessica; Guiles, Daniel; Mulogo, Edgar Mugema; Stone, Geren S.
    In Integrated Community Case Management (iCCM), village health workers (VHW) assess and treat malaria, pneumonia and diarrhea using a clinical algorithm. Study objectives included: 1) Compare VHWs’ performance on case scenario exercises to record review data; 2) assess impact of formal education on performance in the case scenario exercises.36 VHWs in Bugoye Subcounty, Uganda completed the case scenarios exercise, which included video case scenarios and brief oral case vignettes, between July 2017 and February 2018. We obtained clinical records for all iCCM encounters in the same time period.In the video case scenarios, 45% of mock patients received all correct management steps (including all recommended education), while 94% received all critical management steps. Based on the level of data available from record review, 74% of patients in the record review dataset received overall correct management compared to 94% in the video case scenarios. In the case scenarios, VHWs with primary school education performed similarly to those with some or all secondary school education.The case scenarios produced higher estimates of quality of care than record review. VHWs often omitted recommended health education topics in the case scenarios. Level of formal education did not appear to influence performance in the case scenarios.
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    Determinants of treatment completion among rural smear positive pulmonary tuberculosis patients: a cross-sectional survey conducted in south-western Uganda
    (Infectious diseases of poverty, 2017) Mulogo, Edgar Mugema; Nahabwe, Christopher; Bagenda, Fred; Batwala, Vincent
    Treatment completion among tuberculosis patients remains low across various regions of Uganda, despite implementation of directly observed treatment short course. This study evaluated the determinants of treatment completion in a rural health sub-district of south western Uganda.In April 2012, health facility records were reviewed to identify tuberculosis patients who had been initiated on treatment between June 2008 and May 2011, in Rwampara Health Sub-District, south-western Uganda. Out of the 162 patients identified, 128 (79%) were traced and subsequently interviewed during a survey conducted in June 2012. Eleven (6.8%) of the 162 patients died, while 23 (14.2%) could not be traced. A review of records showed that 17 of those that could not be traced completed treatment while the other six did not have definitive records.Treatment completion among the 128 patients interviewed was 89.8%. Pre-treatment counselling (aOR = 24.3, 95% CI: 1.4–26.6, P = 0.03), counselling at the time of submission of sputum during follow up (aOR = 6.8, 95% CI: 1.4–33.7, P = 0.02), and refill of drugs on the exact appointment date (aOR = 13.4, 95% CI: 1.9–93.0, P = 0.01), were independently associated with treatment completion.The level of treatment completion was higher than the national average, with service- related determinants identified as being critical for ensuring treatment completion. These data provide further evidence for the need to provide ongoing counselling support to tuberculosis patients. Enhancing the opportunities for counselling of tuberculosis patients should therefore be rigorously promoted as an approach to increase treatment completion in rural settings.
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    Gaps in Measles Vaccination Coverage in Kasese district, Western Uganda:Results of a Qualitative Evaluation
    (BMC Infectious Diseases, 2022) Walekhwa, Abel Wilson; Musoke, David; Nalugya, Aisha; Biribawa, Claire; Nsereko, Godfrey; Wafula, Solomon Tsebeni; Nakazibwe, Brenda; Nantongo, Mary; Odera, Doreen Awino; Chiara, Achangwa; Boyce, Ross Mathew; Mulogo, Edgar Mugema
    Despite the availability of a highly effective vaccine, measles remains a substantial public health problem in many countries including Uganda. In this study, conducted between June–August 2020 following a local outbreak, we sought to explore the factors that could affect measles vaccination coverage in rural western Uganda.
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    Long-term quality of integrated community case management care for children in Bugoye Subcounty, Uganda: a retrospective observational study
    (BMJ open, 2022) Miller, James S.; Mulogo, Edgar Mugema; Wesuta, Andrew Christopher; Mumbere, Nobert; Mbaju, Jackson; Bwambale, Shem; Stone, Geren S.
    Integrated community case management (iCCM) of childhood illness in Uganda involves protocol-based care of malaria, pneumonia and diarrhoea for children under 5 years old. This study assessed volunteer village health workers’ (VHW) ability to provide correct iCCM care according to the national protocol and change in their performance over time since initial training. VHWs affiliated with the Ugandan national programme provide community-based care in eight villages in Bugoye Subcounty, a rural area in Kasese District. The first cohort of VHWs began providing iCCM care in March 2013, the second cohort in July 2016. All children receiving iCCM care in 18 430 clinical encounters occurring between April 2014 and December 2018. The descriptive primary outcome measure was the proportion of patients receiving overall correct care, defined as adherence to the iCCM protocol for the presenting condition (hereafter quality of care). The analytic primary outcome was change in the odds of receiving correct care over time, assessed using logistic regression models with generalised estimating equations. Secondary outcome measures included a set of binary measures of adherence to specific elements of the iCCM protocol. Preplanned and final measures were the same. Overall, VHWs provided correct care in 74% of clinical encounters. For the first cohort of VHWs, regression modelling demonstrated a modest increase in quality of care until approximately 3 years after their initial iCCM training (OR 1.022 per month elapsed, 95% CI 1.005 to 1.038), followed by a modest decrease thereafter (OR 0.978 per month, 95% CI 0.970 to 0.986). For the second cohort, quality of care was essentially constant over time (OR 1.007 per month, 95% CI 0.989 to 1.025). Quality of care was relatively constant over time, though the trend towards decreasing quality of care after 3 years of providing iCCM care requires further monitoring.