Medical and Health Sciences

Permanent URI for this collection

https://nru.uncst.go.ug/handle/123456789/796

Browse

Now showing 1 - 20 of 68

Access to Health Care Services. Experiences of Persons Living with Disabilities in Eastern and Northern Uganda
(Budget Monitoring and Accountability Unit, 2019) Budget Monitoring and Accountability Unit
Over the last two decades, the Government of Uganda (GoU) has increased access to health services through various programmes and projects including investment in health infrastructure, medicines and other health supplies; and human resource development. Despite the investments, the desired universal health coverage is far from attainment as some sections of the population (persons with disabilities and or clients with special conditions) fail to have easy access to basic health care services. Article 25 of the UN Convention on the Rights of Persons with disabilities (CRPD) states that Parties recognize that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability. It also states Parties shall take all appropriate measures to ensure access for persons with disabilities to health services that are gender-sensitive, including health-related rehabilitation. This briefing paper presents the experiences of persons living with disabilities while seeking health care from selected Health Center IVs (Mungula,Yumbe, Aboke, Kiyunga, Budondo, Busesa, Midigo) in Eastern and Northern Uganda. The issues identified in this paper are a proxy of the status of service delivery at all levels of care thus the proposed recommendations are aimed at addressing overall sector service delivery challenges.
Addressing Inequity and Discrimination in the Delivery of Health Services in Uganda
(Economic and Social Rights Advocacy (ESRA), 2014) Kwemoi, Charles
Health reports in Uganda are often characterized by aggregated statistical data showing progress on particular indicators such as maternal mortality, infant mortality, life expectancy, HIV/AIDS prevalence and so on. However, what the statistics fail to reveal are the individuals and groups of people excluded from the system, who are denied life saving services because of who they are or where they live. In applying a human rights perspective, it is imperative for policy makers to persistently peer behind the veil of lump-sum statistics and to test the universality and equitability of healthcare access and services. This is the second issue of the Economic and Social Rights Advocacy (ESRA) Brief published by the Initiative for Social and Economic Rights (ISER). The ESRA Brief is dedicated to Economic and Social Rights (ESRs) advocacy in Uganda but draws on key lessons from the broader East African Community. The Brief is intended for policy makers, civil society actors, development partners and the donor community as it provides insight into the debates and steps currently being undertaken by Ugandan organizations individually and collaboratively to achieve the full realization of ESRs.
Addressing regional disparities in access to child and maternal health services
(Economic Policy Research Centre, 2016) Ahaibwe, Gemma
Ensuring healthy lives through access to essential, affordable, quality health care for ‘all’ is the cornerstone of sustainable development and is what proponents of Universal Health Care (UHC) advocate for. Although Uganda has made some progress towards UHC, challenges remain with persistent inequality in access to maternal and child care services. Using the recently concluded MDG framework as an example, Uganda’s achievement on the various MDGS was mixed. A number of health related goals- which are of interest to this brief remained unachieved by the close of the September 2015 deadline; Uganda failed to reduce by three quarters, between 1990 and 2015, the maternal mortality ratio and narrowly missed target 4A that aimed to reduce the under-five mortality rate by two thirds, between 1990 and 2015.1 To date in Uganda, an estimated 16 women still die every day from preventable causes linked to pregnancy and child birth while approximately 90 per 1000 live births still die from preventable causes annually. Disaggregated analysis further reveals stark regional disparities in health outcomes; the PRDP region2 and in particular the Northern region continues to lag behind the rest of the country – hence pulling down national human development progress. As we embark on the journey towards achieving Sustainable Development Goals by 2030 which call for ‘leaving no one behind”, there is a need to address binding constraints in such lagging areas. This brief unpacks the disparities in achievements in maternal and child related health outcomes for the PRDP region in comparison to the rest of the country and proposes reforms aimed at accelerating the movement towards universal health coverage.
Addressing the Poor Nutrition of Ugandan Children
(Economic Policy Research Centre (EPRC), 2012) Ssewanyana, Sarah; Kasirye, Ibrahim
One out of every three young children in Uganda are short for their age, according to the 2011 Uganda Demographic and Health Survey (UDHS); and the incidence of poor nutritional status is highest in the relatively better off sub region of South Western Uganda. Although poor child nutrition status is a pervasive global problem, it is mainly concentrated in a few developing countries. According to the United Nations Children’s Fund (UNICEF) 24 developing countries account for over 80 percent of the world’s 195 million children faced with stunting. Out of the 24 countries, at least 11 are from Sub Saharan Africa (SSA). Furthermore, countries in SSA have made the least progress in reducing stunting rates—from 38% to 34% between 1990 and 2008—compared to a reduction of 40% to 29% for all developing countries. Uganda is among the developing countries with the largest population of stunted children—an estimated 2.4 million children aged less than 5 years in Uganda are stunted and this places the country at the rank of 14th—based on the ranking of countries with large populations of nutritionally challenged children
Adolescent motherhood and maternal deaths in Uganda
(Economic Policy Research Centre, 2020) Economic Policy Research Centre
Despite the reduction in the rate of maternal deaths during child birth over the past decade, Uganda’s maternal mortality ratio (MMR)remains high compared to other East African countries. At 375 deaths per 100,000 live births in 2017, Uganda’s MMR is 51 percent more than that of Rwanda (248 deaths per 100,000 live birth). On the other hand, the major causes of maternal deaths during child birth in Uganda are preventable. Major drivers of maternal deaths include the high prevalence of teenage pregnancy and associated adolescent motherhood as well as inequitable distribution of health facilities across the country.
Advocacy For Affordable Malaria Diagnosis In Uganda
(HEPS, 2018) HEPS
Malaria is the biggest single cause of illness and death in Uganda. The country has the third highest number of malaria deaths and one of the highest reported malaria transmission rates in the world. Malaria accounts for 30%-50% of outpatient visits, 15%-20% of hospital admissions, and up to 20% of all hospital deaths. Overall about 16 million cases and about 10,500 deaths are reported per year. Early diagnosis and treatment of malaria reduces disease and prevents deaths. Accurate diagnosis is vital to good malaria case management. Testing makes treatment more effective; allows a health work to carry out further investigations on a patientwho tests negative; and plays a central role in combatting rising levels of resistance to anti-malarial medicines. It also contributes to reducing malaria transmission. The National Malaria Control Policy recommends that parasite-based diagnosis with microscopy or malaria rapid diagnostic test (mRDT) before treatment is performed for any suspected malaria cases. However, access to testing is still far from universal. An end-use verification (EUV) survey conducted in April 2016 by the US President’s Malaria Initiative (PMI) found that only 69% of the treated malaria cases received a diagnostic test – still lower than the 90% national target, but an improvement from the 2015 survey (61%). Malaria diagnosis in the public sector is in principle accessed free of charge, but in the private sector it accessed at a cost. A poll conducted by HEPS Uganda and Trac Fm among 3,200 listeners of eight FM radio stations spread in different parts of Uganda – conducted in January and February 2017 – showed that up to 24% of them do not test for malaria before treatment because of high prices of the test. In addition, the number of mRDT manufacturers and mRDT brands have increased rapidly over the past few years. These have led to different prices, which has created confusion among policy makers, service providers and service consumers alike and undermined access and confidence in making choices. High prices also result from the fact that some importers are – against policy – taxed. Others are not taxed, but make provision for taxes – which they the pass on to consumers in form of high prices for fear that future tax audits may require them to pay tax arrears.
An Agricultural Extension Program Reduces Malaria Infections in Uganda
(United States Agency for International Development (USAID), 2019) Pan, Yao; Singhal, Saurabh
Despite the rapid decline in malaria worldwide over the last decade, Sub-Saharan Africa still accounts for about 90 percent of malaria-related deaths.1 A primary reason why families choose not to purchase bed nets or other products that can protect them from malaria-infected mosquitoes is that they can’t afford them. In Uganda we found evidence that the additional income generated by a large-scale agricultural extension program reduced malaria infections by increasing rates of bed net ownership. This result shows that even unrelated programs that increase household income can play a role in reducing malaria infection.
Analysis of the Mental Health Bill, 2014: Submission to the Health Committee of the Parliament of Uganda on February 8, 2018
(Initiative for Social and Economic Rights (ISER), 2018) Initiative for Social and Economic Rights (ISER)
The current legislation governing mental health in Uganda is the Mental Treatment Act, Cap 279 which was enacted in 1964. It has long been overtaken by key developments and interventions including, and most importantly, the adoption of the United Nations Convention on the Rights of Persons with Disabilities (CRPD)1 and its ratification by Uganda. From the use of derogatory terms such as ‘idiots’ and ‘persons suffering from mental derangement’ to subjecting PWDs to forced medical interventions without consent, and detention for indeterminable periods of time, the Mental Treatment Act violates the human rights of persons with psychosocial and intellectual disabilities to dignity, physical and mental integrity, independence, liberty, and freedom from cruel, inhuman and degrading treatment.
Better nutrition for children in Uganda The policy makers role
(Economic Policy Research Centre (EPRC), 2012) Kasirye, Ibrahim
Uganda has made tremendous progress in improving welfare outcomes in the past 20 years, some key welfare outcomes especially regarding nutritional status have performed dismally. For instance, the proportion of poor persons reduced from 56% in 1992 to 25% by 2010. Also, the infant mortality rate (IMR) reduced from 81 to 54 death per 1000 live birth during 1995-2011. Similarly, the HIV/AIDS prevalence rate reduced from 30% in the early 1990s to 6.7% by 2011. On the other hand, Uganda continues to maintain a large population of malnourished children and women and this dents the country’s impressive human development record. According to population based data from Uganda Demographic and health Surveys (UDHS) of 2006 and 2011, 2,314,620 children under the age of five are too short for their age (stunted). An estimated 250,000 children under the age of five suffer from severe acute malnutrition annually and are in need of medical treatment. However, the most recent estimates from the 2011 UDHS indicate that child stunting rates have declined in the past five years. The proportion of children aged below 5 years classified as stunted declined from 38% in 2006 to 33% by 2011 (Figure 1). Furthermore Figure 1 shows that Uganda has registered mixed progress regarding child nutritional health indicators and the country may not meet the Millennium Development Goal (MDG) 1 target of halving Uganda’s underweight levels from 25% in 1990 to 12% by 2015. Worse still, Uganda appears to off the mark with regard to the target of halving the population below the minimum level of dietary energy consumption— the level of food insecurity has remained above the 60% mark since the 1990s.
Building Effective Drinking Water Management Policies In Rural Africa: Lessons From Northern Uganda
(CIGI-Africa Initiative, 2012) Opio, Christopher
The importance of providing clean, safe drinking water and sanitation to rural inhabitants of developing countries is widely recognized. The United Nations (UN) General Assembly, for instance, declared 2008 the International Year of Sanitation, and the World Bank has been increasing financial assistance to developing countries in support of water supply and sanitation improvements (Cho, Ogwang and Opio, 2010). Despite the Millennium Development Goal (MDG) to reduce, by half, the number of people without sustainable access to clean and safe drinking water and basic sanitation by 2015 (Cho, Ogwang and Opio, 2010; Opio, 2010), most countries in Sub-Saharan Africa are not on track to meet the widely adopted deadline (Harvey, 2007; United Nations Children’s Fund [UNICEF], 2012; Abenaitwe, 2012).
Civil Soceity Asks For Mechanisms For Broader And Regular Monitoring Of Access To Essential Medicines In The Next Uganda Pharmaceutical Plan
(HEPS-Uganda, 2017) HEPS-Uganda
Uganda’s Constitution and National Drug Policy recognise access to medicines – a fundamental element of the right to health1 – as a goal of State health programmes and interventions. The Constitution requires the State to take all practical measures to ensure the provision of basic medical services, of which medicines are an essential part, to the population.2 And, through the National Drug Policy, the State accordingly aims to ensure the availability and accessibility of adequate quantities of affordable, efficacious, safe, and high quality essential medicines and health supplies (EMHS)3 to all people at all times. In an effort to achieve access, Government and development partners, have increased funding for EMHS and implemented reforms in the logistics and supply chain system. In 2008/09, total Government and donor EMHS expenditure on (including for this period off-budget projects) was estimated at US$139 million (Ushs 347 billion) or about $ 4.5 per capita.4 In this regard, the U.S. Government was the largest single source of EMHS funding (35.4% of total expenditure) followed closely by Government of Uganda (33.4%) and then by CHAI (10.4%), Global Alliance for Vaccines and Immunization 9.5%, and The Global Fund to Fight AIDS, Tuberculosis and Malaria 4% and other development partners 7.3%. One of the most important reforms has been the creation of a separate budget vote for EMHS (Vote 116) effective July 2009. In 2011/12, EMHS funding through National Medical Stores (NMS) – handling only about one half of medicines consumed in the public and private-not-for-profit sectors – only reached Ushs204 billion.5 Another major reform has been a move away from a “pull system” to a “push system” of EMHS for lower-level health facilities, which a pre-determined kit or basket of EMHS.
Community engagement and its implications for latrine Coverage and better hygiene and sanitation practices
(UNICEF, 2017) UNICEF
The International Decade for Action - Water for life 2005-2015 report states that sanitation remains a powerful indicator of the state of human development in any community. Access to sanitation bestows benefits at many levels. Cross-country studies show that the method of disposing of excreta is one of the strongest determinants of child survival: the transition from unimproved to improved sanitation reduces overall child mortality by about a third. Improved sanitation also brings advantages for public health, livelihoods and dignity-advantages that extend beyond households to entire communities.
Community involvement in MDP 301 microbicide trial in Masaka: Successes and failures
(HEPS-Uganda Policy Briefing Series, 2010) HEPS
The MDP 301 microbicide trial used multiple approaches at the Masaka site to mobilise and sensitise the community, get feedback, share information, and communicate the final trial results. While this broad approach contributed to the success of the trial, a survey conducted early 2010 found no evidence that civil society advocacy groups were invited to contribute to the trial’s design and implementation. By outlining the key successes and failures of the trial’s community involvement initiatives, this brief highlights the need for HIV prevention research in general to follow good community participatory practice guidelines by nurturing local advocates from the civil society to partner with the investigators in the conduct of research.
Cost Effectiveness of Reproductive Health Interventions in Uganda: The Case for Family Planning services
(The African Economic Research Consortium, 2013) Ssewanyana, Sarah; Kasirye, Ibrahim
There seems to be a consensus among policymakers and politicians that innovative interventions have to be put in place to reduce the population growth rates in Uganda. The country’s population growth rate of 3.2% per annum is extremely high — even for a low income country. The above scenario is attributed to high number births per woman as measured by the Total Fertility Rate (TFR) and this has remained substantially above levels elsewhere in sub‐Saharan Africa (SSA). For example, in 2006 Uganda’s TFR of 6.7 births per woman was higher than the SSA average of 5.5 births per woman. On the other hand, with an annual per capita Gross Domestic Product (GDP) of US$ 300, Uganda remains one of the poorest countries in SSA. Furthermore, due to the predominance of informal activities and weak tax administration system, the country collects only 13.7 % of its GDP in taxes. As such the amount of funds available for financing health services in general and reproductive health services in particular are limited.
Costs and effects of different ART scale-up options in Uganda
(MRC/UVRI Research Unit on AIDS., 2016) McCreesh, Nicky; Andrianakis, Loannis; Nsubuga, Rebecca N.; Hayes, Richard; White, Richard G.; London School of Hygiene and Tropical Medicine, MRC/UVRI Research Unit on AIDS.
Effect of the Transposable Element Environment of Human Genes on Gene Length and Expression
(Genome biology and evolution, 2011) Jjingo, Daudi; Huda, Ahsan; Gundapuneni, Madhumati; Leonardo Mari o-Ramırez, Leonardo Marin˜ o-Ramı´rez3,4, and I. King Jordan; Jordan, I. King
Independent lines of investigation have documented effects of both transposable elements (TEs) and gene length (GL) on gene expression. However, TE gene fractions are highly correlated with GL, suggesting that they cannot be considered independently. We evaluated the TE environment of human genes and GL jointly in an attempt to tease apart their relative effects. TE gene fractions and GL were compared with the overall level of gene expression and the breadth of expression across tissues. GL is strongly correlated with overall expression level but weakly correlated with the breadth of expression, confirming the selection hypothesis that attributes the compactness of highly expressed genes to selection for economy of transcription. However, TE gene fractions overall, and for the L1 family in particular, show stronger anticorrelations with expression level than GL, indicating that GL may not be the most important target of selection for transcriptional economy. These results suggest a specific mechanism, removal of TEs, by which highly expressed genes are selectively tuned for efficiency. MIR elements are the only family of TEs with gene fractions that show a positive correlation with tissue-specific expression, suggesting that they may provide regulatory sequences that help to control human gene expression. Consistent with this notion, MIR fractions are relatively enriched close to transcription start sites and associated with coexpression in specific sets of related tissues. Our results confirm the overall relevance of the TE environment to gene expression and point to distinct mechanisms by which different TE families may contribute to gene regulation.
Expanding HIVAIDS prevention programmes through Safe Male Circumcision and Voluntary Counselling and Testing in Uganda
(2013) Ahaibwe, Gemma; Kasirye, Ibrahim; Barungi, Mildred
Although Uganda initially registered large reductions in HIV/AIDS prevalence rate during the 1990s, the rate of new HIV infection is on the rise across the country. At least 1.2 million Ugandans are infected with the HIV virus1 . Recent evidence from the 2011 Uganda AIDS Indicator Survey revealed that the HIV/AIDS prevalence rate had increased from 6.4 percent in 2004/5 to 7.3 percent by 20112. The trends in new HIV infections in figure 1 suggest that the annual number of new HIV infections increased by 11.4 percent from 115,775 in 2007/08 to 128,980 in 2010/11, despite the huge amounts of resources earmarked for HIV/AIDS related expenditures. The increase in the HIV/AIDS prevalence has been blamed on the complacency of Ugandans with the availability of anti-retrovaral therapies (ARTs)— especially regarding sexual behavior.
Family Planning Commodity Financing And Supply Chain In Uganda
(HEPS, 2021) HEPS
Uganda was represented at the 2012 London Family Planning (FP) Summit at the highest political level by President Yoweri Museveni who pledged to ensure an enabling policy environment to allow women to exercise their FP choices, to increase the country’s financial investment in FP, and to strengthen service delivery. Government of Uganda (GOU) pledged to increase its annual budget allocation for FP supplies from USD 3.3 million (FY 2012) to USD 5 million for the next five years and to mobilize an additional USD 5 million annually from donors. This would be supported by the development of a reproductive health (RH) sub-account to track RH resource flows. During the 2017 London FP Summit, GOU renewed its FP2020 commitments, but this time around the it pledged to raise an additional USD 20 million annually from Health Development Partners (HDPs) to top up on to the USD 5 million annually from the domestic budget. A substantial number of clients access FP commodities from the private sector through out-of-pocket payments. Out-of-pocket payments expose the population to catastrophic and impoverishing health expenditures, increasing socioeconomic inequality, thereby undermining progress towards Universal Health Coverage (UHC). The national health insurance scheme (NHIS), which would have cushioned people against such risks, has dragged and existing schemes do not cover FP. FP commodities for use in the public sector are included in the Uganda Clinical Guidelines (UCG) and the Essential Medicines and Health Supplies (EMHS) List of Uganda. These commodities also must be registered by the National Drug Authority (NDA). The Ministry of Health’s National RMNCAH Quantification Report guides GOU and partners on the quantities of commodities required and when to procure them. Guided by the Supply Plans in the quantification report, GOU and Health Development Partners (HDPs) make financial commitments andand initiate the procurements of the commodities.The main funders of FP commodities include GOU, UNFPA, USAID and the Global Fund. GOU funding consists of direct allocations from the national budget and grants and loans from HDPs. The commodities are then cleared through customs and warehoused at National Medical Stores (NMS) for the public sector and Joint Medical Store (JMS) for private-not-for-profit (PNFP) sector. In spite of the increased financial allocation by GOU and HDPs to FP commodities, major gaps in financing and access to contraceptives continue to persist in Uganda. The financial need for FP for FY2020/21 is estimated at USD 32.93 million, of which GOU’s contribution from domestic resources is estimated at USD 4.21 million, leaving a funding gap of USD 28.72 million to be filled by HDPs, grants and loans. It is important to note that out of the domestic finances invested in FP commodities,98% of these investments have been used to procure mama kits. Additionally, in 2020, World Bank donated USD 15 million (UGX 57 billion) from its maternal child health project to the COVID-19 national response. Part of these funds had been intended for sexual and reproductive health (SRH) essential medicines and commodities, including FP commodities.
Fertility in African communities affected by HIV
(MRC/UVRI Research Unit on AIDS., 2011) Lutalo, Tom; Ssempijja, Victor
Uganda is famous for its success in bringing down HIV levels, but has persistently high fertility: on average women have seven children by the time they finish childbearing. The resulting high rates of population growth are detrimental to development and will make it difficult for high quality health and education services to keep up with the growing population.
Genetic Diversity of Bundibugyo Ebolavirus from Uganda and the Democratic Republic of Congo
(bioRxiv, 2021) Omara, Isaac Emmanuel; Kiwuwa-Muyingo, Sylvia; Balinandi, Stephen; Nyakarahuka, Luke; Kiconco, Jocelyn; Kayiwa, John Timothy; Mboowa, Gerald; Jjingo, Daudi; Lutwama, Julius J.
The Ebolavirus is one of the deadliest viral pathogens which was first discovered in the year 1976 during two consecutive outbreaks in the Democratic Republic of Congo and Sudan. Six known strains have been documented. The Bundibugyo Ebolavirus in particular first emerged in the year 2007 in Uganda. This outbreak was constituted with 116 human cases and 39 laboratory confirmed deaths. After 5 years, it re-emerged and caused an epidemic for the first time in the Democratic Republic of Congo in the year 2012 as reported by the WHO. Here, 36 human cases with 13 laboratory confirmed deaths were registered. Despite several research studies conducted in the past, there is still scarcity of knowledge available on the genetic diversity of Bundibugyo Ebolavirus. We undertook a research project to provide insights into the unique variants of Bundibugyo Ebolavirus that circulated in the two epidemics that occurred in Uganda and the Democratic Republic of Congo

Browse

Browsing Medical and Health Sciences by Title

Results Per Page

Sort Options