Objectives: The first objective of the study was to develop an index termed as the ‘Imaging Cover... more Objectives: The first objective of the study was to develop an index termed as the ‘Imaging Coverage ’ (IC), for measuring the performance of the imaging health systems. This index together with the Hospital-Based Utilization (HBU) would then be calculated for five Ugandan hospitals. Second, was to relate the financial resources and existing health policy to the performance of the imaging systems. Materials and Methods: This was a cross-sectional survey employing the triangulation methodology, conducted in Mulago National Referral Hospital. The qualitative study used cluster sampling, in-depth interviews, focus group discussions, and self-administered questionnaires to explore the non-measurable aspects of the imaging systems ’ performances. Results: The IC developed and tested as an index for the imaging system’s performance was 36%. General X-rays had the best IC followed by ultrasound. The Hospital-Based Utilization for the five selected hospitals was 186 per thousand and was the...
Abstract. Use of community health workers (CHWs) has been implemented the same way in urban and r... more Abstract. Use of community health workers (CHWs) has been implemented the same way in urban and rural areas despite differences in availability of health providers and sociodemographic characteristics. A household survey was conducted in rural and urban areas in eastern Uganda, and all children who were febrile in the previous two weeks were assessed for their symptoms, treatment received at home, and when and where they first went for treatment. Rural children were more likely to use CHWs than urban children. Urban children received outside treatment more promptly, and used herbs at home less. Symptoms and proportion of children being taken out for treatment were similar. Children from the poorest households used CHWs less and private providers more than the middle quintiles. Drug shops and private clinics should be included in the community case management to cater for the poorest in rural areas and persons in urban areas.
This chapter highlights the main ethical issues that arise in addressing the challenges of global... more This chapter highlights the main ethical issues that arise in addressing the challenges of global human resources for health (HRH). It includes a brief overview of global HRH problems including shortages and poor working conditions that lead to pressures on the international labor market for health workers, as well as strategies that countries and the global community have taken to mitigate them. The main ethical issues that arise in dealing with global HRH are presented. These include equity of access to quality health care, implications of public versus private health care provision, privacy and confidentiality, fairness to health workers in personnel policies and practices, and managing the push and pull factors in the labor market that lead to the pressure for international migration of health personnel. The chapter highlights existing global conventions that could help governments and other policymakers to alleviate these challenges in a more ethically responsible way.
Background: Uganda has not achieved the 2005 neonatal tetanus (NNT) global elimination target set... more Background: Uganda has not achieved the 2005 neonatal tetanus (NNT) global elimination target set by the World Health Organization (WHO). The Busoga region has the highest recorded level of NNT incidence in Uganda. To understand the reasons for this high incidence, a study was conducted to identify NNT risk factors. Methods: During March-May 2004, a matched case-control study was conducted in the Busoga region for a 2-year study period (2002-2003). Matching variables were sex, residence, and date of birth. A total of 24 cases of NNT (according to the WHO case definition) were identified from hospital records, and 96 community controls (children who survived the neonatal period) were selected. Results: Bivariate analysis indicated that neonates with NNT were more likely to have been delivered outside a health facility, on an unclean surface, without use of gloves, or by unskilled attendants. Mothers of these neonates were less likely to report vaccination during previous pregnancies, administration of 2 doses of tetanus toxoid (TT) during the study pregnancy, or use of certain intravaginal substances (most commonly, herbs) at onset of labor. Multivariate analysis indicated that unclean delivery surfaces (odds ratio [OR] = 38.8; 95% confidence interval [CI] = 2.9-518.1) and primigravidae mothers (OR = 79.5; CI = 1.8-3,472.2) were associated with NNT. Administration of 2 doses of TT during pregnancy, vaccination during previous pregnancies, and intravaginal application of certain substances were protective against NNT. Conclusion: These findings underscore the importance of having clean delivery surfaces and of mothers receiving 2 doses of TT during pregnancy. Implementation of these measures might help eliminate NNT from the Busoga region of Uganda.
In an effort to contain the frequently devastating epidemics in sub-Saharan Africa, the World Hea... more In an effort to contain the frequently devastating epidemics in sub-Saharan Africa, the World Health Organization (WHO) Regional Office for Africa launched the Integrated Disease Surveillance and Response (IDSR) strategy in an effort to strengthen surveillance and response. However, 36 sub-Saharan African countries have been described as experiencing a human resource crisis by the WHO. Given this human resource situation, the challenge remains for these countries to achieve, among others, the health-related Millennium Development Goals (MDGs). This paper describes the process through which the African Field Epidemiology Network (AFENET) was developed, as well as how AFENET has contributed to addressing the public health workforce crisis, and the development of human resource capacity to implement IDSR in Africa. AFENET was established between 2005 and 2006 as a network of Field Epidemiology Training Programs (FETPs) and Field Epidemiology and Laboratory Training Programs (FELTPs) in Africa. This resulted from an expressed need to develop a network that would advocate for the unique needs of African FETPs and FELTPs, provide service to its membership, and through which programs could develop joint projects to address the public health needs of their countries. A total of eight new programs have been developed in sub-Saharan Africa since 2006. Programs established after 2006 represent over 70% of current FETP and FELTP enrolment in Africa. In addition to growth in membership and programs, AFENET has recorded significant growth in external partnerships. Beginning with USAID, CDC and WHO in 2004-2006, a total of at least 26 partners have been added by 2011. Drawing from lessons learnt, AFENET is now a resource that can be relied upon to expand public health capacity in Africa in an efficient and practical manner. National, regional and global health actors can leverage it to meet health-related targets at all levels. The AFENET story is one that continues to be driven by a clearly recognized need within Africa to develop a network that would serve public health systems development, looking beyond the founders, and using the existing capacity of the founders and partners to help other countries build capacity for IDSR and the International Health Regulations (IHR, 2005).
Objectives: The first objective of the study was to develop an index termed as the ‘Imaging Cover... more Objectives: The first objective of the study was to develop an index termed as the ‘Imaging Coverage ’ (IC), for measuring the performance of the imaging health systems. This index together with the Hospital-Based Utilization (HBU) would then be calculated for five Ugandan hospitals. Second, was to relate the financial resources and existing health policy to the performance of the imaging systems. Materials and Methods: This was a cross-sectional survey employing the triangulation methodology, conducted in Mulago National Referral Hospital. The qualitative study used cluster sampling, in-depth interviews, focus group discussions, and self-administered questionnaires to explore the non-measurable aspects of the imaging systems ’ performances. Results: The IC developed and tested as an index for the imaging system’s performance was 36%. General X-rays had the best IC followed by ultrasound. The Hospital-Based Utilization for the five selected hospitals was 186 per thousand and was the...
Abstract. Use of community health workers (CHWs) has been implemented the same way in urban and r... more Abstract. Use of community health workers (CHWs) has been implemented the same way in urban and rural areas despite differences in availability of health providers and sociodemographic characteristics. A household survey was conducted in rural and urban areas in eastern Uganda, and all children who were febrile in the previous two weeks were assessed for their symptoms, treatment received at home, and when and where they first went for treatment. Rural children were more likely to use CHWs than urban children. Urban children received outside treatment more promptly, and used herbs at home less. Symptoms and proportion of children being taken out for treatment were similar. Children from the poorest households used CHWs less and private providers more than the middle quintiles. Drug shops and private clinics should be included in the community case management to cater for the poorest in rural areas and persons in urban areas.
This chapter highlights the main ethical issues that arise in addressing the challenges of global... more This chapter highlights the main ethical issues that arise in addressing the challenges of global human resources for health (HRH). It includes a brief overview of global HRH problems including shortages and poor working conditions that lead to pressures on the international labor market for health workers, as well as strategies that countries and the global community have taken to mitigate them. The main ethical issues that arise in dealing with global HRH are presented. These include equity of access to quality health care, implications of public versus private health care provision, privacy and confidentiality, fairness to health workers in personnel policies and practices, and managing the push and pull factors in the labor market that lead to the pressure for international migration of health personnel. The chapter highlights existing global conventions that could help governments and other policymakers to alleviate these challenges in a more ethically responsible way.
Background: Uganda has not achieved the 2005 neonatal tetanus (NNT) global elimination target set... more Background: Uganda has not achieved the 2005 neonatal tetanus (NNT) global elimination target set by the World Health Organization (WHO). The Busoga region has the highest recorded level of NNT incidence in Uganda. To understand the reasons for this high incidence, a study was conducted to identify NNT risk factors. Methods: During March-May 2004, a matched case-control study was conducted in the Busoga region for a 2-year study period (2002-2003). Matching variables were sex, residence, and date of birth. A total of 24 cases of NNT (according to the WHO case definition) were identified from hospital records, and 96 community controls (children who survived the neonatal period) were selected. Results: Bivariate analysis indicated that neonates with NNT were more likely to have been delivered outside a health facility, on an unclean surface, without use of gloves, or by unskilled attendants. Mothers of these neonates were less likely to report vaccination during previous pregnancies, administration of 2 doses of tetanus toxoid (TT) during the study pregnancy, or use of certain intravaginal substances (most commonly, herbs) at onset of labor. Multivariate analysis indicated that unclean delivery surfaces (odds ratio [OR] = 38.8; 95% confidence interval [CI] = 2.9-518.1) and primigravidae mothers (OR = 79.5; CI = 1.8-3,472.2) were associated with NNT. Administration of 2 doses of TT during pregnancy, vaccination during previous pregnancies, and intravaginal application of certain substances were protective against NNT. Conclusion: These findings underscore the importance of having clean delivery surfaces and of mothers receiving 2 doses of TT during pregnancy. Implementation of these measures might help eliminate NNT from the Busoga region of Uganda.
In an effort to contain the frequently devastating epidemics in sub-Saharan Africa, the World Hea... more In an effort to contain the frequently devastating epidemics in sub-Saharan Africa, the World Health Organization (WHO) Regional Office for Africa launched the Integrated Disease Surveillance and Response (IDSR) strategy in an effort to strengthen surveillance and response. However, 36 sub-Saharan African countries have been described as experiencing a human resource crisis by the WHO. Given this human resource situation, the challenge remains for these countries to achieve, among others, the health-related Millennium Development Goals (MDGs). This paper describes the process through which the African Field Epidemiology Network (AFENET) was developed, as well as how AFENET has contributed to addressing the public health workforce crisis, and the development of human resource capacity to implement IDSR in Africa. AFENET was established between 2005 and 2006 as a network of Field Epidemiology Training Programs (FETPs) and Field Epidemiology and Laboratory Training Programs (FELTPs) in Africa. This resulted from an expressed need to develop a network that would advocate for the unique needs of African FETPs and FELTPs, provide service to its membership, and through which programs could develop joint projects to address the public health needs of their countries. A total of eight new programs have been developed in sub-Saharan Africa since 2006. Programs established after 2006 represent over 70% of current FETP and FELTP enrolment in Africa. In addition to growth in membership and programs, AFENET has recorded significant growth in external partnerships. Beginning with USAID, CDC and WHO in 2004-2006, a total of at least 26 partners have been added by 2011. Drawing from lessons learnt, AFENET is now a resource that can be relied upon to expand public health capacity in Africa in an efficient and practical manner. National, regional and global health actors can leverage it to meet health-related targets at all levels. The AFENET story is one that continues to be driven by a clearly recognized need within Africa to develop a network that would serve public health systems development, looking beyond the founders, and using the existing capacity of the founders and partners to help other countries build capacity for IDSR and the International Health Regulations (IHR, 2005).
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