Acknowledgements We are indebted to all participants who shared their insights with us. In addition, we thank the Healthy Entrepreneurs Uganda Ltd. staff who helped us in arranging our activities. Icons on this poster are made by Freepik.... more
Acknowledgements We are indebted to all participants who shared their insights with us. In addition, we thank the Healthy Entrepreneurs Uganda Ltd. staff who helped us in arranging our activities. Icons on this poster are made by Freepik. Contact information Robert ( @RAJ_Borst) is a health systems researcher at Erasmus School of Health Policy & Management. His research activities center around two themes: a) studying how knowledge platforms in health research are constructed and evolve over time and b) studying global health systems research practices, including the mapping of persisting controversies and inequities (e.g. Hasnida et al., 2016). Please feel free to get in contact during AIDS2018 or by scanning the QR-code below using your smartphone’s camera or a third-party app. Methods The study was conducted using tablet-based surveys in a cluster-randomised cross-sectional cohort study. The sample entailed household members from 25 villages in a rural West-Ugandan district. The association between four validated sexual and reproductive health outcome indicators and exposure to community health entrepreneurship was assessed using wealth-adjusted mixed-effects logistic regression models. . Results Data were obtained from 1202 household members who volunteered to participate (83% female). Table 1 shows the wealth-adjusted odds ratios per indicator. The results show that household members who lived in areas where community health entrepreneurs were active had both higher odds on currently using modern contraception and having knowledge of modern contraceptive methods, sexually transmitted infections, and the symptoms of sexually transmitted infections. Community health entrepreneurship is a sustainable approach to provide sexual and reproductive health care to underserved populations by harnessing the entrepreneurial skills of existing (volunteer) community health workers. This study provides a first evaluation of the impact of the 'Healthy Entrepreneurs' social enterprise model. This model may be key in HIV prevention by proactively ensuring rural populations access to the knowledge and means required for increasing and sustaining sexual and reproductive health. Conclusion In areas where community health entrepreneurs were active, participants had higher odds on using modern contraceptives and had more knowledge of modern contraceptive methods and sexually transmitted infections. This study thus provides evidence of the key role that community health entrepreneurs have in preventing HIV infection and transmission by guaranteeing underserved populations access to sexual and reproductive health products, services, and knowledge. Robert A.J. Borst1, Maarten O. Kok1,2, Isis Jonker2 & Denis Muhangi3 Reaching the rural in Uganda: a cluster-randomised exploration of community health entrepreneurs' impact on sexual and reproductive health
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Decision-making on intra-household allocation of bed nets in Uganda: do households prioritize the most vulnerable members?
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2004 This Study was funded by USAID UPHOLD CSO Study, Phase II Final Report, Dec.2004 i Subcontractor Name: Denis Muhangi
Female community health workers who were trained to become a ‘healthy entrepreneur’ showed an increased and sustained performance in the medium-term. This study provides the first evidence that community health entrepreneurship may be a... more
Female community health workers who were trained to become a ‘healthy entrepreneur’ showed an increased and sustained performance in the medium-term. This study provides the first evidence that community health entrepreneurship may be a sustainable and lasting model through which to organise sexual and reproductive healthcare.
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Research Interests: Communication, Culture, Uganda, Public Health, Medicine, and 10 moreCommunity Health Workers, Social Stigma, Disease Outbreaks, Humans, Public health systems and services research, Public Health Surveillance, Communicable disease control, Outbreak, anthropology cultural, and Residence Characteristics
Background: Recent research shows that psychological distress is on the rise globally as a result of the COVID-19 pandemic and restrictions imposed on populations to manage it. We estimated the burden of psychological distress and... more
Background: Recent research shows that psychological distress is on the rise globally as a result of the COVID-19 pandemic and restrictions imposed on populations to manage it. We estimated the burden of psychological distress and scrutinized the role that social support may play in moderating psychological distress among conflict refugees in urban, semi-rural and rural settlements in Uganda during the COVID-19 pandemic.Methods: Cross-sectional survey data on psychological distress, social support, demographics, socio-economic and behavioral variables was gathered from 1014 adult refugees randomly sampled from urban, semi-rural and rural refugee settlementsin Uganda, using two-staged cluster sampling. Research instruments were checked for reliability using Cronbach’s Alpha. T-test, Analysis of Variance (ANOVA) and Multivariable Linear Regression were applied to analyse the data in SPSS-version 22. Statistical significance was assumed at p<0.05.Results: Refugees resident in rural/...
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Additional file 1. Full transcripts of the three stories selected as part of the studyâ s MSC analysis component.
Objectives: Population size estimates of People Who Inject Drugs (PWIDs) are needed to help policy makers understand the scope of the epidemic and allocate appropriate resources yet little is known about the size estimates of PWIDs in... more
Objectives: Population size estimates of People Who Inject Drugs (PWIDs) are needed to help policy makers understand the scope of the epidemic and allocate appropriate resources yet little is known about the size estimates of PWIDs in Uganda. We aimed to establish the number of people who inject drugs in Kampala Capital City and Mbale Municipality in Uganda. Methods: We integrated three population size estimation methods into a cross-sectional survey of PWIDs in two urban centers. These methods included enumeration, Wisdom of the Crowds and multiplier method. The mean of the three estimates was hypothesized to be the most plausible size estimate with the other results forming the upper and lower plausible bounds. Data were shared with community representatives and stakeholders to finalize ‘best’ point estimates and plausible bounds. Results: We estimate there are approximately 550 PWIDs and 189 PWIDs in Kampala Capital City and Mbale Municipality respectively and plausibly 576-1,695 PWIDs living in these two urban centers. Conclusions: We employed multiple methods and used a wide range of data sources to estimate the size of PWIDs—a hidden population in Kampala Capital City and Mbale Municipality in Uganda. These estimates may be useful to advocate for and to plan, implement and evaluate HIV and Viral Hepatitis response for PWIDs. Key words: People who inject drugs, Population Size Estimates, Enumeration, Multiplier, Uganda
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Comparing healthcare dynamics among orphans and non-orphans in an NGO supported and a non-supported sub-county so as to identify the level of equity. This was a cross-sectional unmatched case-control research. A sample of 98 orphans and... more
Comparing healthcare dynamics among orphans and non-orphans in an NGO supported and a non-supported sub-county so as to identify the level of equity. This was a cross-sectional unmatched case-control research. A sample of 98 orphans and 98 non-orphans in an NGO supported sub-county and a similar number in a control sub-county participated. For each child, a corresponding caregiver participated. Each respondent was interviewed. Analysis was comparative. Relationships between variables were ascertained using a X(2). Fevers were the most common health problem. However, 14.3% of children reported an experience of diarrhoea in an NGO-supported sub-county as opposed to 85.7% in the control sub-county (p = 0.014). Twenty percent of children in the NGO supported sub-county reported skin infections compared to 80% in the control sub-county [p= 0.008]. When orphans fell sick, more caregivers in the supported sub-county consulted village clinics compared to self herbal-medication (p = 0.009). ...
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The Rural Water Supply (RWS) global study was launched by the UNDP-World Bank Water and Sanitation Program to analyze the impact of institutional rules on rural water supply and sustainability in six countries including Uganda. The Uganda... more
The Rural Water Supply (RWS) global study was launched by the UNDP-World Bank Water and Sanitation Program to analyze the impact of institutional rules on rural water supply and sustainability in six countries including Uganda. The Uganda country study was launched in November 1996 taking Rural Water and Sanitation Eastern Uganda Project (RUWASA) as a case study. The general objective of the study was 'to evaluate the comparative impact of RUWASA rules, guidelines and applications, in terms of their responsiveness to demand, on the sustainability of rural water supply (RWS) at community level'. The Uganda study sample was selected from 16 communities/ Local Councils (LC1s) using a two-stage cluster sampling technique in the 2 districts of Kamuli and Mukono which are part of RUWASA catchment area. Although demand-driven projects appear to have greater prospects for sustainability, in many countries, government support to the RWS sector has often focused on designing and const...
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Process evaluation components, questions and data sources matrix (DOCX 15Â kb)
The reporting of child maltreatment in the media provides information about the nature and extent of this phenomenon, while also influencing public opinion. Media reporting of child maltreatment is often not neutral, but rather embeds... more
The reporting of child maltreatment in the media provides information about the nature and extent of this phenomenon, while also influencing public opinion. Media reporting of child maltreatment is often not neutral, but rather embeds assumptions, stereotypes and judgements rooted in different socio-economic and cultural contexts. This chapter, drawing from two print daily newspapers in Uganda from the year 2013, analyses the discourses and representations of child maltreatment in Uganda. A total of 346 newspaper issues were reviewed. Four main discourses are identified with respect to abused children: abused children as innocent vulnerable victims; children as active agents in contributing to their abuse; children as active agents in addressing abuse; and the abused children’s future as a ruined future. The parents of maltreated children are portrayed as unsuspecting and negligent, as active abusers, and in some cases as active agents in addressing child abuse. Other key discourses...
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Page 1. COMPARATIVE STUDIES OF ORPHANS AND NON-ORPHANS IN UGANDA PRINCIPAL INVESTIGATORS Flavia Munaaba Joseph Owor Peter Baguma Seggane Musisi Frank Mugisha Denis Muhangi Page 2. 1 Page 3. 2 COMPARATIVE STUDIES OF ORPHANS ...
The novel Corona Virus (COVID-19) was declared a global pandemic on 30 January 2020 and by the end of the year the number of known cases globally stood at 81million, with a case fatality rate of 2.2%. Across countries, the public health... more
The novel Corona Virus (COVID-19) was declared a global pandemic on 30 January 2020 and by the end of the year the number of known cases globally stood at 81million, with a case fatality rate of 2.2%. Across countries, the public health responses to the pandemic have at the core included the control of transmission risk through initiatives targeting behavioral change at individual, institutional and societal levels. Though the emergence ABSTRACT
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The purpose of the current study was to explore the association between community health entrepreneurship and the sexual and reproductive health status of rural households in West-Uganda. We collected data using digital surveys in a... more
The purpose of the current study was to explore the association between community health entrepreneurship and the sexual and reproductive health status of rural households in West-Uganda. We collected data using digital surveys in a cluster-randomized cross-sectional cohort study. The sample entailed 1211 household members from 25 randomly selected villages within two subcounties, of a rural West-Ugandan district. The association between five validated sexual and reproductive health outcome indicators and exposure to community health entrepreneurship was assessed using wealth-adjusted mixed-effects logistic regression models. We observed that households living in an area where community health entrepreneurs were active reported more often to use at least one modern contraceptive method [odds ratios (OR): 2.01, 95% CI: 1.30–3.10] had more knowledge of modern contraceptive methods (OR: 7.75, 95% CI: 2.81–21.34), knew more sexually transmitted infections (OR: 1.86, 95% CI: 1.14–3.05), ...
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Background The negative impact of COVID-19 on population health outcomes raises critical questions on health system preparedness and resilience, especially in resource-limited settings. This study examined healthworker preparedness for... more
Background The negative impact of COVID-19 on population health outcomes raises critical questions on health system preparedness and resilience, especially in resource-limited settings. This study examined healthworker preparedness for COVID-19 management and implementation experiences in Uganda’s refugee-hosting districts. Methods A cross sectional, mixed-method descriptive study in 17 health facilities in 7 districts from 4 major regions. Total sample size was 485 including > 370 health care workers (HCWs). HCW knowledge, attitude and practices (KAP) was assessed by using a pre-validated questionnaire. The quantitative data was processed and analysed using SPSS 26, and statistical significance assumed at p
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In this chapter, we argue that international declarations, global agendas and national agendas, including programs geared at “Education For All,” have made substantial contributions in improving the education status of girls and boys in... more
In this chapter, we argue that international declarations, global agendas and national agendas, including programs geared at “Education For All,” have made substantial contributions in improving the education status of girls and boys in general. In the context of Uganda, while these measures cannot be discounted, the girl child still faces enormous social structure and cultural barriers, not only in accessing education and surviving through the primary education level, but also in transitioning to lower secondary education. This is illustrated with evidence based on the analysis of enrollment and survival rates of girls in primary education for more than one decade. The gender based inequalities perpetuated by social structure and cultural barriers within a patriarchal society are partly to blame for the challenges the girl child faces, but more so, a failure of the educational planners to tailor interventions to meet the critical needs of the girls in the education system are to blame. Factors such as teenage pregnancy and early marriages, and the long term consequences they manifest, further undermine the girl child education. Other factors, including the quality of education as implied by the inadequate infrastructure, understaffing, teacher absenteeism, lack of access to food and a general loss of interest in the education, generally affect the education of girls and boys. This chapter highlights, among other issues, the opportunity to tap into modern forms of technology to break down barriers to girls’ education, designing social protection packages that meet the needs of girls while schooling and generally targeting mass sensitization to change the way the girl child is socially constructed in order to build positive attitudes among parents and community persons to support the education of the girl child.
Drawing from ethnographic data collected between 2012 and 2014 and January and June 2018 in Luwero district, Uganda, this article questions the romanticised depiction of burial groups as a means of enhancing social support, a sense of... more
Drawing from ethnographic data collected between 2012 and 2014 and January and June 2018 in Luwero district, Uganda, this article questions the romanticised depiction of burial groups as a means of enhancing social support, a sense of solidarity and mutual aid. We found that the felt sense of identity and belonging for members is not shared across community members, and that solidary relations between members and non-group members in the community are fraught with tensions and conflicts. Beyond the romanticised view of burial groups, we need to study burial groups as a model of solidarity in disunity and diversity.
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The distribution of long-lasting insecticidal nets (LLINs) through universal coverage campaigns is a widely adopted approach for the prevention of malaria at scale. While post-distribution surveys play a valuable role in determining... more
The distribution of long-lasting insecticidal nets (LLINs) through universal coverage campaigns is a widely adopted approach for the prevention of malaria at scale. While post-distribution surveys play a valuable role in determining cross-sectional levels of LLIN retention and use, as well as frequently cited reasons for non-use, few studies have explored the consistency of LLIN use over time, within the expected lifespan of the net, and the factors which may drive this. In this qualitative study, 74 in-depth interviews were conducted with (male) household heads and (female) caregivers of children in LLIN recipient households, as well as community health workers, in Buliisa, Hoima and Kiboga districts in Uganda, 25-29 months following a LLIN mass campaign distribution. A triangulation approach to data analysis was taken, incorporating thematic analysis, most significant change and positive deviance. The factors found to be most influential in encouraging long-term LLIN use were positive experience of net use prior to the distribution, and appreciation or awareness of a range of benefits arising from their use, including protection from malaria as well as importantly, other health, lifestyle, social and economic benefits. Social support from within the community was also identified as an important factor in determining continued use of LLINs. Net use appeared to be more consistent amongst settled urban and rural communities, compared with fishing, pastoralist, refugee and immigrant communities. A multitude of interplaying factors encouraged consistent LLIN use in this setting. Whilst the protection of malaria remains a powerful motivator, social and behaviour change (SBC) strategies should also capitalize on the non-malaria benefits of net use that provide a long-term rationale for consistent use. Where supplies are available, SBC campaigns should promote replacement options, emphasizing ongoing net care and replacement as a household responsibility, thus reducing dependence on free distributions. The triangulation approach to qualitative data analysis enabled increased confidence in the validity of findings and an enhanced contextual understanding of the factors promoting consistent net use in mid-western Uganda. The approach should be considered when designing future studies to explore factors driving net retention and use trends.
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Comparing healthcare dynamics among orphans and non-orphans in an NGO supported and a non-supported sub-county so as to identify the level of equity. This was a cross-sectional unmatched case-control research. A sample of 98 orphans and... more
Comparing healthcare dynamics among orphans and non-orphans in an NGO supported and a non-supported sub-county so as to identify the level of equity. This was a cross-sectional unmatched case-control research. A sample of 98 orphans and 98 non-orphans in an NGO supported sub-county and a similar number in a control sub-county participated. For each child, a corresponding caregiver participated. Each respondent was interviewed. Analysis was comparative. Relationships between variables were ascertained using a X(2). Fevers were the most common health problem. However, 14.3% of children reported an experience of diarrhoea in an NGO-supported sub-county as opposed to 85.7% in the control sub-county (p = 0.014). Twenty percent of children in the NGO supported sub-county reported skin infections compared to 80% in the control sub-county [p= 0.008]. When orphans fell sick, more caregivers in the supported sub-county consulted village clinics compared to self herbal-medication (p = 0.009). ...
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This review aimed to identify international literature on the triple provision combination of social welfare services (SWS) embedded within programmes where cash transfers are conditional (CCT) on school attendance in order to inform best... more
This review aimed to identify international literature on the triple provision combination of social welfare services (SWS) embedded within programmes where cash transfers are conditional (CCT) on school attendance in order to inform best policy and practice. The review found only one example of such provision, descriptions of which indicated a benefit of the triple combination approach yet did not provide an in-depth evaluation of the link with SWS. More relevant evidence and indications for future research and policy were found within literature concerned with the double combination of SWS and schooling, including extended and full-service schools. However, this has not yet been linked to CCT. This literature reports an overall positive impact of a SWS and school integration for both children and families, while noting several complexities and challenges such as resource availability and management issues. Methodologies are currently diverse. A Theory of Change approach may represent an optimum strategy for future programme evaluations to address the complex synergies of inputs and outcomes. Also, the definition of SWS needs to be refined as appropriate to countries of the global South, where the triple combination is of particular relevance.