Browsing by Author "Ochola, Emmanuel"

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    A One Health approach toward the control and elimination of soil-transmitted helminthic infections in endemic areas
    (IJID One Health, 2024-03-22) Lapat, Jolly Joe; Opee, Jimmyy; Apio, Monica Clara; Akello, Susan; Ojul, Christine Lakop; Ochola, Emmanuel; Bongomin, Felix
    Soil-transmitted helminths (STHs) pose significant health challenges, particularly in developing countries. Over 2 billion people are estimated to have been infected with at least one STH species. These parasites rely on the soil for part of their life cycle and are transmitted to humans through ova ingestion or skin penetration. Key risk factors include poor water, sanitation, hygiene practices, limited healthcare access, and poverty. Globally, STHs are primarily controlled through chemo-preventive deworming of high-risk groups in moderate (where prevalence of STHs is between 20 % and 50 %) to highly endemic areas (prevalence >50 %). Despite the use of deworming to control the STHs in endemic areas, infections still occur. The aim of this article is to explore the potential for enhancing STH control and elimination as Neglected Tropical Diseases (NTDs) in endemic areas through an integrated approach—the One Health approach. The current control program has a single strategy of chemoprophylaxis; in the integrated approach to control of STHs, the parasite control strategies besides being based on the epidemiology of the parasite (endemicity), also include strategies based on the biology (transmission cycle) of the parasites and human behavior patterns in endemic areas. Through the involvement of local communities, healthcare authorities, and stakeholders, participatory approaches foster collaborative efforts to devise and implement control measures. By integrating this integrated approach into existing healthcare and educational initiatives, more effective results can be achieved. The promotion of health education, clean water access, improved sanitation, and hygiene awareness can further enhance control strategies and reduce STH prevalence sustainably. Here, we highlight the benefits of adopting an integrated (One Health) approach to tackle STHs in endemic areas. Through community empowerment and multi-sectorial collaboration, we can strengthen our collective efforts to combat STHs and alleviate the burden of these NTDs.
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    Communities and service providers address access to perinatal care in post conflict Northern Uganda: socializing evidence for participatory action
    (Fam Med Com Health, 2021) Belaid, Loubna; Atim, Pamela; Atim, Eunice; Ochola, Emmanuel; Ogwang, Martin; Bayo, Pontius; Oola, Janet; Wonyima Okello, Isaac; Sarmiento, Ivan; Rojas-Rozo, Laura; Zinszer, Kate; Zarowsky, Christina; Andersson, Neil
    Describe participatory codesign of interventions to improve access to perinatal care services in Northern Uganda. Study design Mixed-methods participatory research to codesign increased access to perinatal care. Fuzzy cognitive mapping, focus groups and a household survey identified and documented the extent of obstructions to access. Deliberative dialogue focused stakeholder discussions of this evidence to address the obstacles to access. Most significant change stories explored the participant experience of this process. Setting Three parishes in Nwoya district in the Gulu region, Northern Uganda. Participants Purposively sampled groups of women, men, female youth, male youth, community health workers, traditional midwives and service providers. Each of seven stakeholder categories included 5–8 participants in each of three parishes. Results Stakeholders identified several obstructions to accessing perinatal care: lack of savings in preparation for childbirth in facility costs, lack of male support and poor service provider attitudes. They suggested joining saving groups, practising saving money and income generation to address the short-term financial shortfall. They recommended increasing spousal awareness of perinatal care and they proposed improving service provider attitudes. Participants described their own improved care-seeking behaviour and patient–provider relationships as short-term gains of the codesign. Conclusion Participatory service improvement is feasible and acceptable in postconflict settings like Northern Uganda. Engaging communities in identifying perinatal service delivery issues and reflecting on local evidence about these issues generate workable community-led solutions and increases trust between community members and service providers.
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    Healthcare providers’ perceptions on screening for Intimate Partner Violence in healthcare: A qualitative study of four health centres in Uganda
    (Open Journal of Preventive Medicine, 2013) Lawoko, Stephen; Seruwagi, Gloria K.; Marunga, Iryne; Mutto, Milton; Ochola, Emmanuel; Oloya, Geoffrey; Piloya, Joyce; Lubega, Muhamadi
    The current qualitative study explored the per-ceptions of healthcare providers on screening for Intimate Partner Violence (IPV) in healthcare in Uganda, to develop a conceptual framework for factors likely to hinder/promote IPV screen-ing in the country. Using purposive sampling, the study enlisted 54 healthcare workers (doc-tors and nurses) from four hospitals (i.e. Gulu referral hospital, Iganga referral hospital, Lacor hospital, Anaka hospital) to participate in eight focus group discussions. Data was thematically analysed using Template Analysis. The study found support for an ecological framework suggesting a complex interaction of factors at the individual (e.g. poor skills in detection of IPV by health workers and unwillingness to disclose abuse by patients), organisational (e.g. under-staffing and lack of protocols for IPV screening) and societal (e.g. societal acceptance of abuse of women and poor policy on IPV management) levels as potential barriers to the practice of IPV screening in healthcare Uganda. These findings have important implications on further training of healthcare workers to adequately screen for IPV, re-organisation of the healthcare system so that it is fully-fledged to accommodate IPV scree- ning and improved collaboration between the health sector and other community advocates in IPV management. These initiatives should run concurrently with a concerted community sen-sitization effort aimed at modifying attitudes towards IPV among care providers and recipi-ents a like, as well as preparing the general population to will-fully disclose IPV to health- workers. Study limitations and implications for further research are discussed.
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    High burden of hepatitis B infection in Northern Uganda: results of a population-based survey
    (BMC Public Health, 2013) Ochola, Emmanuel; Ocama, Ponsiano; Orach, Christopher G.; Nankinga, Ziadah K.; Kalyango, Joan N.; McFarland, Willi; Karamagi, Charles
    Worldwide 2 billion people are exposed to hepatitis B infection, 350 million have chronic infection, 65 million in sub-Saharan Africa. Uganda is highly endemic with 10% national prevalence of hepatitis B infection, rates varying across the country from 4% in the southwest and 25% in the Northeast. Childhood vaccination was rolled out in 2002, the effect of which on the burden of hepatitis B has not been examined. We determined the prevalence and risk factors for hepatitis B infection in the Northern Uganda Municipality of Gulu. Methods: We carried out a cross-sectional, population-based survey. The study population included those found at home at the time of recruitment. Data on demographics, wealth index, cultural and behavioral factors, vaccination and health education on hepatitis B were collected. Hepatitis B infection (Hepatitis B surface antigen positive) and lifetime exposure (anti-hepatitis B core antibody positive) were measured. Analysis was done in 2 age groups, 1–14 years, 14 years and more. Associations between predictors and HBV infection were assessed. Results: Information on 790 respondents were analyzed. Overall, 139/790 (17.6%) had hepatitis B infection and 572/790 (72.4%) lifetime exposure. In the younger age group 16/73 (21.9%) had hepatitis B infection and 35/73 (48%) lifetime exposure. Increasing wealth was protective for infection (OR 0.46 per quartile, 95% CI=0.26-0.82, p=0.009), while older age was protective for lifetime exposure (OR 2.70 per age group, 95% CI 1.03-7.07, p=0.043). In the older age group, overall hepatitis B infection was seen in 123/717 (17.2%) and lifetime exposure in 537/717 (74.9%). The female sex (OR 0.63, 95% CI=0.42-0.98, p=0.032) and increasing age (OR 0.76 per age group, 95% CI=0.64-0.91, p=0.003) were factors associated with infection. For lifetime exposure, increasing number of lifetime sexual partners was a risk factor (OR 1.19 per partner category, 95% CI=1.04-1.38, p=0.012). Conclusions: We found a high prevalence of hepatitis B infection and lifetime exposures to hepatitis B in this northern Uganda Municipality. Targeted vaccination of susceptible adults and improving existing childhood vaccinations and provision of treatment for those with infection will play roles in reducing the high prevalence rates seen in the population.
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    Inquiry about Domestic Violence against Women in Healthcare Uganda: Do Practitioner Attitudes, Role Conflicts, Efficacy, Safety Concerns and Support Networks Play a Role?
    (Psychology, 2014) Ehrenberg, Louise; Lawoko-Olwe, Winnie; Loum, Bishop; Oketayot, Kenneth; Akot, Margarete; Kiyembe, Charles; Ochola, Emmanuel; Guwatudde, David; Lawoko, Stephen
    We scrutinized the extent of inquiry about domestic violence against women by practitioners in healthcare Uganda, and its relationship with individual, professional and organization factors. Specifically, we hypothesized that the frequency of IPV inquiry in healthcare would be associated with practitioner attitudes, professional role conflicts, self-efficacy, provider/client safety and system support. Methods: The Domestic Violence Healthcare Provider Survey Scale questionnaire was administered to a random sample of 376 health care providers (n = 250 valid responses) from Gulu, Anaka, Lacor and Iganga hospital situated in northern and eastern Uganda. The data was analyzed using chi-square tests, correlation tests and ordinal regressions analyses. Results and Conclusions: We found that over a three-month period, the majority of participants (31%) had inquired about domestic violence exposure among clients between 4 - 6 times, with 18% having not inquired at all. As hypothesized, low self-efficacy, poor availability of a support network, high professional role conflicts/fears of offending patients, and concerns about victim/provider safety reduced the probability of IPV inquiry. These findings have implications for the reorganization of the health care settings, review of organization policy and further training of car
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    Policy Implementation Challenges and Barriers to Access Sexual and Reproductive Health Services Faced By People With Disabilities: An Intersectional Analysis of Policy Actors’ Perspectives in Post-Conflict Northern Uganda
    (Int J Health Policy Manag, 2021) Mac-Seing, Muriel; Ochola, Emmanuel; Ogwang, Martin; Zinszer, Kate; Zarowsky, Christina
    Emerging from a 20-year armed conflict, Uganda adopted several laws and policies to protect the rights of people with disabilities, including their sexual and reproductive health (SRH) rights. However, the SRH rights of people with disabilities continue to be infringed in Uganda. We explored policy actors’ perceptions of existing pro-disability legislation and policy implementation, their perceptions of potential barriers experienced by people with disabilities in accessing and using SRH services in post-conflict Northern Uganda, and their recommendations on how to redress these inequities. Methods: Through an intersectionality-informed approach, we conducted and thematically analysed 13 in-depth semi-structured interviews with macro level policy actors (national policy-makers and international and national organisations); seven focus groups (FGs) at meso level with 68 health service providers and representatives of disabled people’s organisations (DPOs); and a two-day participatory workshop on disability-sensitive health service provision for 34 healthcare providers. Results: We identified four main themes: (1) legislation and policy implementation was fraught with numerous technical and financial challenges, coupled with lack of prioritisation of disability issues; (2) people with disabilities experienced multiple physical, attitudinal, communication, and structural barriers to access and use SRH services; (3) the conflict was perceived to have persisting impacts on the access to services; and (4) policy actors recommended concrete solutions to reduce health inequities faced by people with disabilities. Conclusion: This study provides substantial evidence of the multilayered disadvantages people with disabilities face when using SRH services and the difficulty of implementing disability-focused policy in Uganda. Informed by an intersectionality approach, policy actors were able to identify concrete solutions and recommendations beyond the identification of problems. These recommendations can be acted upon in a practical road map to remove different types of barriers in the access to SRH services by people with disabilities, irrespective of their geographic location in Uganda.
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    Readiness to Screen for Domestic Violence against Women in Healthcare Uganda: Associations with Demographic, Professional and Work Environmental Factors
    (Open Journal of Preventive Medicine, 2014) Lawoko, Stephen; Ochola, Emmanuel; Oloya, Geoffrey; Piloya, Joyce; Lubega, Muhamadi; Lawoko-Olwe, Winnie; Guwatudde, David
    We assessed demographic, professional and work environmental determinants of readiness to screen for Intimate Partner Violence among healthcare practitioners in healthcare Uganda. Methods: The Domestic Violence Healthcare Provider Survey Scale and the Demand-Control-Support questionnaire was administered to a random sample of 376 health care providers (n = 279 valid responses) from Gulu, Anaka, Lacor and Iganga hospital situated in northern and eastern Uganda. Correlation tests, t-tests, ANOVA and Multiple Linear regression were used to analyse the data. Results: Male care providers were more likely than female peers to blame the victim for the occurrence of Intimate Partner Violence in a relationship. Participants from Lacorhospital graded a lower self-efficacy and a poorer support network with regard to screening for Intimate partner violence, and a higher propensity to blame the victim when contrasted with other hospitals. Doctors experienced a lower self-efficacy with regard to IPV screening than other professions. Blaming the victim for abuse was associated with a high work load and low support at work. In addition, with increasing work control and support, participants’ appraisal of system support and self-efficacy increased. Conclusion: Gender, profession, facility of work, work demand, control and support are important determinants of the readiness to screen for IPV in healthcare Uganda, and should inform strategy for the introduction and implementation of routine IPV inquiry in healthcare Uganda.