David Musoke - Academia.edu (original) (raw)

Papers by David Musoke

PLOS global public health, Jun 21, 2024

Community Health Workers (CHWs) are a key human resource for health particularly in lowand middle... more Community Health Workers (CHWs) are a key human resource for health particularly in lowand middle-income countries. In many parts of the world, CHWs are known to have played an instrumental role in controlling the COVID-19 pandemic. This study explored the involvement of CHWs in the COVID-19 response in Uganda. A qualitative study that involved 10 focus group discussions (FGDs) among CHWs was conducted. The study was carried out in 5 districts of Amuria, Karenga, Kamwenge, Bugiri and Pader. The FGD guide used explored the role of CHWs in the COVID-19 response in their communities including lived experiences, challenges, and coping mechanisms. The data were analyzed thematically with the support of NVivo version 12 pro (QSR International). CHWs were at the frontline of COVID-19 prevention interventions at households and in the community. CHWs raised awareness on prevention measures including wearing face masks, hand hygiene, and social distancing. They identified suspected cases such as new members entering the community, as well as individuals returning from abroad with signs and symptoms of COVID-19. CHWs mobilized the community and increased awareness on COVID-19 vaccination which played an important role in reducing misinformation. They also supported home-based management of mild COVID-19 cases through isolation of patients; provided health and nutritional guidance among patients in their homes; and referred suspected cases to health facilities for testing and management. Both monetary and non-monetary incentives were provided to support CHWs in the COVID-19 response. However, the adequacy and timing of the incentives were inadequate. Routine services of CHWs such as health promotion and treatment of childhood illnesses were disrupted during the pandemic. CHWs played an instrumental role in response to the pandemic especially on surveillance, risk communication, and observance of preventing measures. Strategies to ensure that routine services of CHWs are not disrupted during pandemics are needed.

Journal of Pharmaceutical Policy and Practice

Background Private pharmacies are the first point of contact for the public regarding acquisition... more Background Private pharmacies are the first point of contact for the public regarding acquisition of medicines and other pharmaceuticals in many low- and middle-income countries including Uganda. Most antimicrobial stewardship (AMS) programmes in Uganda have targeted pharmacies in public health facilities, with little known about private pharmacies. This study explored knowledge and practices related to AMS in private pharmacies in Wakiso district, central Uganda. Methods This was a qualitative study that involved 31 in-depth interviews to explore AMS among retail private pharmacy staff including pharmacists, pharmacy technicians/dispensers, and nurses. Participants were asked about antimicrobial resistance (AMR) and AMS practices at their pharmacy. The audio-recorded interviews were transcribed verbatim and imported to NVivo 2020 (QSR International) for thematic analysis. Results Five major themes emerged from the study: commonly sold antimicrobials; knowledge on AMR and AMS; poten...

Infection and Drug Resistance

African Health Sciences

Aim: We examined the maternal healthcare-seeking behaviour of peri-urban women with disabilities ... more Aim: We examined the maternal healthcare-seeking behaviour of peri-urban women with disabilities in Busiro South Health Sub District, Wakiso district, Uganda. Methods: This community-based cross-sectional study. Data were collected using semi-structured questionnaires and focus group discussions. Chi-square was used to test for differences, and logistic regression to determine factors associated with maternal health-seeking behaviour at a 5% level of significance. Content analysis was used to analyse qualitative data. Results: A total of 182 women with disabilities were enrolled. Overall, 150 (82.3%) of the disabled women had attended ANC and 147 (80.8%) had delivered their babies at a health facility. The participants' mean age was 31.9±7.8years (range: 17-49 years). ANC attendance among disabled women was influenced by maternal age 18-30 years (p = 0.010), number of times a disabled woman was pregnant (p = 0.003), parity (p = 0.018), a normal delivery (p = 0.048), receiving fi...

BackgroundExtended-spectrum beta-lactamase-producingEscherichia coli(ESBL-PE) represents a signif... more BackgroundExtended-spectrum beta-lactamase-producingEscherichia coli(ESBL-PE) represents a significant global public health concern. Much as humans, animals and environments harbor ESBL-PE, its epidemiology in Uganda is still not well understood. This study explains the epidemiology of ESBL-PE using the one health approach in selected farming households in Wakiso district, central Uganda.MethodologyEnvironmental, human, and animal samples were collected from 104 households. Additional data were obtained using observation checklists and through interviews with household members using a semi-structured questionnaire. Surface swabs, soil, water, human and animal fecal samples were introduced onto ESBL chromogenic agar. The isolates were identified using biochemical tests and double-disk synergy tests. To assess associations, prevalence ratios (PRs) were computed using a generalized linear model (GLM) analysis with modified Poisson and a log link with robust standard errors in R softwar...

Health Research Policy and Systems, 2021

Background Community health worker (CHW) programmes are again receiving more attention in global ... more Background Community health worker (CHW) programmes are again receiving more attention in global health, as reflected in important recent WHO guidance. However, there is a risk that current CHW programme efforts may result in disappointing performance if those promoting and delivering them fail to learn from past efforts. This is the first of a series of 11 articles for a supplement entitled “Community Health Workers at the Dawn of a New Era”. Methods Drawing on lessons from case studies of large well-established CHW programmes, published literature, and the authors’ experience, the paper highlights major issues that need to be acknowledged to design and deliver effective CHW programmes at large scale. The paper also serves as an introduction to a set of articles addressing these issues in detail. Results The article highlights the diversity and complexity of CHW programmes, and offers insights to programme planners, policymakers, donors, and others to inform development of more eff...

Nutrition Journal, 2020

Background Healthy and sustainable dietary practices offer a possible solution to competing tensi... more Background Healthy and sustainable dietary practices offer a possible solution to competing tensions between health and environmental sustainability, particularly as global food systems transition. To encourage such dietary practices, it is imperative to understand existing dietary practices and factors influencing these dietary practices. The aim of this study was to identify multi-level factors in lived rural and urban Ugandan food environments that influence existing dietary practices among women of reproductive age (WRA). Methods A mixed methods study was conducted. Multiple correspondence analysis followed by hierarchical cluster analysis were performed on dietary data collected among a sample (n = 73) of Ugandan WRA in Kampala (urban) and Wakiso (rural) districts to elicit dietary clusters. Dietary clusters, which were labelled as dietary typologies based on environmental impact and nutrition transition considerations, were reflective of dietary practices. Following this, a sm...

One Health Outlook, 2020

The interconnections of humans, domestic animals, wildlife and the environment have increasingly ... more The interconnections of humans, domestic animals, wildlife and the environment have increasingly become complex, requiring innovative and collaborative approaches (One Health approach) for addressing global health challenges. One Health is a multidisciplinary and multi-sectoral collaborative approach to human, animal, plant and environmental health. The role of academia in training professionals oriented in One Health is critical in building a global workforce capable of enhancing synergies of various sectors in improving health.Makerere University, Uganda has implemented pre-service capacity building initiatives aimed to foster One Health competencies among students who are future practitioners. In addition to incorporating the One Health concept in didactic curricula, Student One Health Innovation Clubs, undergraduate field placements in 11 demonstration sites, graduate fellowships, small grants to support research and innovations, and cross-college collaborative training approach...

Journal of Water, Sanitation and Hygiene for Development, 2020

We explored the facilitators and barriers to uptake of water, sanitation and hygiene (WASH) inter... more We explored the facilitators and barriers to uptake of water, sanitation and hygiene (WASH) interventions among slum dwellers in Kampala, Uganda using a socio-ecological perspective. This qualitative exploration used focus group discussions with community members and key informant interviews with community leaders and technocrats to collect data. Among facilitators to uptake of WASH interventions were susceptibility to WASH-related diseases and low WASH knowledge levels at individual level, peer practices at household level, and promotion of WASH at organizational level. At community and public policy levels, community engagement and empowerment, and formation and enforcement of ordinances and bye-laws, respectively, motivated slums dwellers to adopt WASH interventions. Conversely, individual knowledge, beliefs, language, and financial status inhibited individuals from taking up WASH interventions. Negative peer practices and upbringing at peer level; unsupportive environments, and ...

International Health, 2020

Background This study assessed characteristics of sanitation and hygiene facilities in a slum com... more Background This study assessed characteristics of sanitation and hygiene facilities in a slum community in Kampala, Uganda. Methods We conducted a household-based cross-sectional study among 395 households in Kasubi slum using a semi-structured questionnaire and observational checklist to collect data. Results Almost 98.0% (387/395) of households owned a sanitation facility and 77.0% (298/387) shared it with other households. The most common type of sanitation facility was a pit latrine with slab (66.9% [259/387]). Most (90.5% [305/337]) latrines had a door or shutter, a roof (92.9% [313/337]) and a depth >1.5 m (68.2% [229/337]). Overall, 21.3% (84/395) and 65.6% (259/395) of households had improved and functional sanitation facilities, respectively. Only 16.5% (65/395) of the households had a hand-washing facility. Student-led (adjusted prevalence rate [PR] 2.67 [95% confidence interval [CI] 1.83–3.94]) and households that owned their house (adjusted PR 2.17 [95% CI 1.33–3.53])...

Rwanda Journal of Engineering, Science, Technology and Environment, 2020

The ecological sanitation (Ecosan) technology continues to be challenged by diverse factors inclu... more The ecological sanitation (Ecosan) technology continues to be challenged by diverse factors including exposure of human excreta to the users in different geographical settings. The purpose of the study is to understand the linkage between the uptake of Ecosan technology and theapplication of human excreta on the farms among farmers in Burera district. A quantitative study was conducted to assess the linkage between the application of human excreta on the farms and the uptake of Ecosan technology among farmers of Burera District, Northern Province of Rwanda. By using a multistage sampling strategy, a sample of 361 household farmers was selected in the sectors of Rugarama, Gahunga and Cyanika in the District of Burera where the Ecosan technology has been mostly implemented at the household level Findings show that Ecological sanitation technology is favorable among females and 70% of females prefer to use it as sanitation facilities due to its privacy and design compared to the pitla...

Background: In Uganda women with disabilities attend antenatal care (ANC) while pregnant, however... more Background: In Uganda women with disabilities attend antenatal care (ANC) while pregnant, however, majority of these deliver from the hands of Traditional Birth Attendants (TBAs) due to due to fear of being mistreated by skilled birth attendants. We explored the determinants of the maternal health seeking behavior of women with disability in Busiro health sub district (HSD), Wakiso district, Uganda. Methods: A community based cross-sectional study involving quantitative and qualitative methods of data collection was conducted among 182 participants. Quantitative data were collected from disabled women, and qualitative data from six key informants (midwives and in-charges) at selected health facilities in Busiro HSD, Wakiso district. Logistic regression was used to determine the factors in uencing the decision to seek maternal health care services (ANC and delivery at health facilities) among women with disability. Qualitative data were analyzed by content analysis. Results: The ndings revealed that 82.3% of women with disability attended ANC during pregnancy, and of these, 80.8% delivered their babies at health facilities. Attendance of ANC by the women with disability was in uenced by parity (having 1-3 children) (AOR 7.7; 95% CI: 0.249-239.040), mode of delivery-normal delivery verses caesarian section (AOR 2.6, 95%CI: 0.296-22921), place visited during pregnancy TBA visa vie public health facilities (AOR 4.5, 95%CI: 0.922-22.576), and distance to the health facility being less than 5 Kilometres (AOR 2.3 95% CI: 0.695-7.661). Conclusion: There is need to intensify awareness of the use of skilled health workers during pregnancy and child birth to women with disability in the communities so as to improve uptake of maternal health care services.

African Health Sciences

Background: Timely health care among children with suspected malaria, and intermittent preventive... more Background: Timely health care among children with suspected malaria, and intermittent preventive treatment (IPTp) in pregnancy avert related morbidity and mortality in endemic regions especially in sub-Saharan Africa. Malaria burden has steadily been declining in endemic countries due to progress made in scaling up of such important interventions. Objectives: The study assessed malaria health seeking practices for children under five years of age, and IPTp in Wakiso district, Uganda. Methods: A structured questionnaire was used to collect data from 727 households. Chi-square and Fisher’s exact tests were performed in STATA to ascertain factors associated with the place where treatment for children with suspected malaria was first sought (government versus private facility) and uptake of IPTp. Results: Among caretakers of children with suspected malaria, 69.8% sought care on the day of onset of symptoms. The place where treatment was first sought for the children (government versus ...

Wellcome Open Research, 2022

In sub-Saharan Africa (sSA), there is high morbidity and mortality from severe bacterial infectio... more In sub-Saharan Africa (sSA), there is high morbidity and mortality from severe bacterial infection and this is compounded by antimicrobial resistance, in particular, resistance to 3rd-generation cephalosporins. This resistance is typically mediated by extended-spectrum beta lactamases (ESBLs). To interrupt ESBL transmission it will be important to investigate how human behaviour, water, sanitation, and hygiene (WASH) practices, environmental contamination, and antibiotic usage in both urban and rural settings interact to contribute to transmission of ESBL E. coli and ESBL K. pneumoniae between humans, animals, and the environment. Here we present the protocol for the Drivers of Resistance in Uganda and Malawi (DRUM) Consortium, in which we will collect demographic, geospatial, clinical, animal husbandry and WASH data from a total of 400 households in Uganda and Malawi. Longitudinal human, animal and environmental sampling at each household will be used to isolate ESBL E. coli and ES...

Background: Initiating antenatal care within the first trimester and making at least four visits ... more Background: Initiating antenatal care within the first trimester and making at least four visits during pregnancy are recommended to enable screening and support for healthy lifestyles, well-being, and self-care in pregnancy. Due to glaring evidence on inequalities in access to antenatal care, this study assessed the effect of engaging community health structures on utilization of antenatal care services during pregnancy in resource-constrained rural settings in Uganda. Methods: A quasi-experimental evaluation study was conducted among mothers in Eastern Uganda. The intervention components included community dialogues and empowering community health workers to sensitize expectant mothers on the use of maternal health services, and health facility strengthening. The primary outcomes were early initiation of antenatal care and completion of at least 4 ANC visits. We used Difference in Differences (DiD) analysis and multivariate regression to assess the effect of the intervention on AN...

Journal of Pharmaceutical Policy and Practice, 2021

Background Inappropriate use of antimicrobials in both humans and animals is a key driver of anti... more Background Inappropriate use of antimicrobials in both humans and animals is a key driver of antimicrobial resistance (AMR). In addition, human behaviours such as poor disposal of antimicrobials in the environment can increase their exposure to microbes which can impact on humans and animals. However, evidence on access, use and disposal of antimicrobials for humans and animals at community level in Uganda is limited. This study therefore explored access, use and disposal of antimicrobials among humans and animals in Wakiso district, Uganda. Methods A qualitative study was conducted that involved focus group discussions (FGDs) and key informant interviews (KIIs). Participants of the FGDs were community health workers (CHWs) and farmers involved in animal husbandry, while key informants included: officials from the Ministry of Health; Ministry of Agriculture, Animal Industry and Fisheries; human and animal health professionals; district health officials; and members of the national A...

BMJ Global Health, 2020

Provenance and peer review Not commissioned; externally peer reviewed. Data availability statemen... more Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement All data relevant to the study are included in the article.

Environmental Health and Preventive Medicine, 2021

Antimicrobial resistance (AMR) is increasingly becoming a threat to global public health, not lea... more Antimicrobial resistance (AMR) is increasingly becoming a threat to global public health, not least in low- and middle-income countries (LMICs) where it is contributing to longer treatment for illnesses, use of higher generation drugs, more expenditure on antimicrobials, and increased deaths attributed to what should be treatable diseases. Some of the known causes of AMR include misuse and overuse of antimicrobials in both humans and animals, unnecessary use of antimicrobials in animals as growth promoters, and lack of awareness among the public on how to protect antimicrobials. As a result, resistant organisms are circulating in the wider environment, and there is a need to consider the One Health approach to minimise the continuing development of AMR. Environmental Health, specifically water, sanitation and hygiene (WASH), waste management, and food hygiene and safety, are key components of One Health needed to prevent the spread of antimicrobial-resistant microorganisms particula...

PLOS global public health, Jun 21, 2024

Community Health Workers (CHWs) are a key human resource for health particularly in lowand middle... more Community Health Workers (CHWs) are a key human resource for health particularly in lowand middle-income countries. In many parts of the world, CHWs are known to have played an instrumental role in controlling the COVID-19 pandemic. This study explored the involvement of CHWs in the COVID-19 response in Uganda. A qualitative study that involved 10 focus group discussions (FGDs) among CHWs was conducted. The study was carried out in 5 districts of Amuria, Karenga, Kamwenge, Bugiri and Pader. The FGD guide used explored the role of CHWs in the COVID-19 response in their communities including lived experiences, challenges, and coping mechanisms. The data were analyzed thematically with the support of NVivo version 12 pro (QSR International). CHWs were at the frontline of COVID-19 prevention interventions at households and in the community. CHWs raised awareness on prevention measures including wearing face masks, hand hygiene, and social distancing. They identified suspected cases such as new members entering the community, as well as individuals returning from abroad with signs and symptoms of COVID-19. CHWs mobilized the community and increased awareness on COVID-19 vaccination which played an important role in reducing misinformation. They also supported home-based management of mild COVID-19 cases through isolation of patients; provided health and nutritional guidance among patients in their homes; and referred suspected cases to health facilities for testing and management. Both monetary and non-monetary incentives were provided to support CHWs in the COVID-19 response. However, the adequacy and timing of the incentives were inadequate. Routine services of CHWs such as health promotion and treatment of childhood illnesses were disrupted during the pandemic. CHWs played an instrumental role in response to the pandemic especially on surveillance, risk communication, and observance of preventing measures. Strategies to ensure that routine services of CHWs are not disrupted during pandemics are needed.

Journal of Pharmaceutical Policy and Practice

Background Private pharmacies are the first point of contact for the public regarding acquisition... more Background Private pharmacies are the first point of contact for the public regarding acquisition of medicines and other pharmaceuticals in many low- and middle-income countries including Uganda. Most antimicrobial stewardship (AMS) programmes in Uganda have targeted pharmacies in public health facilities, with little known about private pharmacies. This study explored knowledge and practices related to AMS in private pharmacies in Wakiso district, central Uganda. Methods This was a qualitative study that involved 31 in-depth interviews to explore AMS among retail private pharmacy staff including pharmacists, pharmacy technicians/dispensers, and nurses. Participants were asked about antimicrobial resistance (AMR) and AMS practices at their pharmacy. The audio-recorded interviews were transcribed verbatim and imported to NVivo 2020 (QSR International) for thematic analysis. Results Five major themes emerged from the study: commonly sold antimicrobials; knowledge on AMR and AMS; poten...

Infection and Drug Resistance

African Health Sciences

Aim: We examined the maternal healthcare-seeking behaviour of peri-urban women with disabilities ... more Aim: We examined the maternal healthcare-seeking behaviour of peri-urban women with disabilities in Busiro South Health Sub District, Wakiso district, Uganda. Methods: This community-based cross-sectional study. Data were collected using semi-structured questionnaires and focus group discussions. Chi-square was used to test for differences, and logistic regression to determine factors associated with maternal health-seeking behaviour at a 5% level of significance. Content analysis was used to analyse qualitative data. Results: A total of 182 women with disabilities were enrolled. Overall, 150 (82.3%) of the disabled women had attended ANC and 147 (80.8%) had delivered their babies at a health facility. The participants' mean age was 31.9±7.8years (range: 17-49 years). ANC attendance among disabled women was influenced by maternal age 18-30 years (p = 0.010), number of times a disabled woman was pregnant (p = 0.003), parity (p = 0.018), a normal delivery (p = 0.048), receiving fi...

BackgroundExtended-spectrum beta-lactamase-producingEscherichia coli(ESBL-PE) represents a signif... more BackgroundExtended-spectrum beta-lactamase-producingEscherichia coli(ESBL-PE) represents a significant global public health concern. Much as humans, animals and environments harbor ESBL-PE, its epidemiology in Uganda is still not well understood. This study explains the epidemiology of ESBL-PE using the one health approach in selected farming households in Wakiso district, central Uganda.MethodologyEnvironmental, human, and animal samples were collected from 104 households. Additional data were obtained using observation checklists and through interviews with household members using a semi-structured questionnaire. Surface swabs, soil, water, human and animal fecal samples were introduced onto ESBL chromogenic agar. The isolates were identified using biochemical tests and double-disk synergy tests. To assess associations, prevalence ratios (PRs) were computed using a generalized linear model (GLM) analysis with modified Poisson and a log link with robust standard errors in R softwar...

Health Research Policy and Systems, 2021

Background Community health worker (CHW) programmes are again receiving more attention in global ... more Background Community health worker (CHW) programmes are again receiving more attention in global health, as reflected in important recent WHO guidance. However, there is a risk that current CHW programme efforts may result in disappointing performance if those promoting and delivering them fail to learn from past efforts. This is the first of a series of 11 articles for a supplement entitled “Community Health Workers at the Dawn of a New Era”. Methods Drawing on lessons from case studies of large well-established CHW programmes, published literature, and the authors’ experience, the paper highlights major issues that need to be acknowledged to design and deliver effective CHW programmes at large scale. The paper also serves as an introduction to a set of articles addressing these issues in detail. Results The article highlights the diversity and complexity of CHW programmes, and offers insights to programme planners, policymakers, donors, and others to inform development of more eff...

Nutrition Journal, 2020

Background Healthy and sustainable dietary practices offer a possible solution to competing tensi... more Background Healthy and sustainable dietary practices offer a possible solution to competing tensions between health and environmental sustainability, particularly as global food systems transition. To encourage such dietary practices, it is imperative to understand existing dietary practices and factors influencing these dietary practices. The aim of this study was to identify multi-level factors in lived rural and urban Ugandan food environments that influence existing dietary practices among women of reproductive age (WRA). Methods A mixed methods study was conducted. Multiple correspondence analysis followed by hierarchical cluster analysis were performed on dietary data collected among a sample (n = 73) of Ugandan WRA in Kampala (urban) and Wakiso (rural) districts to elicit dietary clusters. Dietary clusters, which were labelled as dietary typologies based on environmental impact and nutrition transition considerations, were reflective of dietary practices. Following this, a sm...

One Health Outlook, 2020

The interconnections of humans, domestic animals, wildlife and the environment have increasingly ... more The interconnections of humans, domestic animals, wildlife and the environment have increasingly become complex, requiring innovative and collaborative approaches (One Health approach) for addressing global health challenges. One Health is a multidisciplinary and multi-sectoral collaborative approach to human, animal, plant and environmental health. The role of academia in training professionals oriented in One Health is critical in building a global workforce capable of enhancing synergies of various sectors in improving health.Makerere University, Uganda has implemented pre-service capacity building initiatives aimed to foster One Health competencies among students who are future practitioners. In addition to incorporating the One Health concept in didactic curricula, Student One Health Innovation Clubs, undergraduate field placements in 11 demonstration sites, graduate fellowships, small grants to support research and innovations, and cross-college collaborative training approach...

Journal of Water, Sanitation and Hygiene for Development, 2020

We explored the facilitators and barriers to uptake of water, sanitation and hygiene (WASH) inter... more We explored the facilitators and barriers to uptake of water, sanitation and hygiene (WASH) interventions among slum dwellers in Kampala, Uganda using a socio-ecological perspective. This qualitative exploration used focus group discussions with community members and key informant interviews with community leaders and technocrats to collect data. Among facilitators to uptake of WASH interventions were susceptibility to WASH-related diseases and low WASH knowledge levels at individual level, peer practices at household level, and promotion of WASH at organizational level. At community and public policy levels, community engagement and empowerment, and formation and enforcement of ordinances and bye-laws, respectively, motivated slums dwellers to adopt WASH interventions. Conversely, individual knowledge, beliefs, language, and financial status inhibited individuals from taking up WASH interventions. Negative peer practices and upbringing at peer level; unsupportive environments, and ...

International Health, 2020

Background This study assessed characteristics of sanitation and hygiene facilities in a slum com... more Background This study assessed characteristics of sanitation and hygiene facilities in a slum community in Kampala, Uganda. Methods We conducted a household-based cross-sectional study among 395 households in Kasubi slum using a semi-structured questionnaire and observational checklist to collect data. Results Almost 98.0% (387/395) of households owned a sanitation facility and 77.0% (298/387) shared it with other households. The most common type of sanitation facility was a pit latrine with slab (66.9% [259/387]). Most (90.5% [305/337]) latrines had a door or shutter, a roof (92.9% [313/337]) and a depth >1.5 m (68.2% [229/337]). Overall, 21.3% (84/395) and 65.6% (259/395) of households had improved and functional sanitation facilities, respectively. Only 16.5% (65/395) of the households had a hand-washing facility. Student-led (adjusted prevalence rate [PR] 2.67 [95% confidence interval [CI] 1.83–3.94]) and households that owned their house (adjusted PR 2.17 [95% CI 1.33–3.53])...

Rwanda Journal of Engineering, Science, Technology and Environment, 2020

The ecological sanitation (Ecosan) technology continues to be challenged by diverse factors inclu... more The ecological sanitation (Ecosan) technology continues to be challenged by diverse factors including exposure of human excreta to the users in different geographical settings. The purpose of the study is to understand the linkage between the uptake of Ecosan technology and theapplication of human excreta on the farms among farmers in Burera district. A quantitative study was conducted to assess the linkage between the application of human excreta on the farms and the uptake of Ecosan technology among farmers of Burera District, Northern Province of Rwanda. By using a multistage sampling strategy, a sample of 361 household farmers was selected in the sectors of Rugarama, Gahunga and Cyanika in the District of Burera where the Ecosan technology has been mostly implemented at the household level Findings show that Ecological sanitation technology is favorable among females and 70% of females prefer to use it as sanitation facilities due to its privacy and design compared to the pitla...

Background: In Uganda women with disabilities attend antenatal care (ANC) while pregnant, however... more Background: In Uganda women with disabilities attend antenatal care (ANC) while pregnant, however, majority of these deliver from the hands of Traditional Birth Attendants (TBAs) due to due to fear of being mistreated by skilled birth attendants. We explored the determinants of the maternal health seeking behavior of women with disability in Busiro health sub district (HSD), Wakiso district, Uganda. Methods: A community based cross-sectional study involving quantitative and qualitative methods of data collection was conducted among 182 participants. Quantitative data were collected from disabled women, and qualitative data from six key informants (midwives and in-charges) at selected health facilities in Busiro HSD, Wakiso district. Logistic regression was used to determine the factors in uencing the decision to seek maternal health care services (ANC and delivery at health facilities) among women with disability. Qualitative data were analyzed by content analysis. Results: The ndings revealed that 82.3% of women with disability attended ANC during pregnancy, and of these, 80.8% delivered their babies at health facilities. Attendance of ANC by the women with disability was in uenced by parity (having 1-3 children) (AOR 7.7; 95% CI: 0.249-239.040), mode of delivery-normal delivery verses caesarian section (AOR 2.6, 95%CI: 0.296-22921), place visited during pregnancy TBA visa vie public health facilities (AOR 4.5, 95%CI: 0.922-22.576), and distance to the health facility being less than 5 Kilometres (AOR 2.3 95% CI: 0.695-7.661). Conclusion: There is need to intensify awareness of the use of skilled health workers during pregnancy and child birth to women with disability in the communities so as to improve uptake of maternal health care services.

African Health Sciences

Background: Timely health care among children with suspected malaria, and intermittent preventive... more Background: Timely health care among children with suspected malaria, and intermittent preventive treatment (IPTp) in pregnancy avert related morbidity and mortality in endemic regions especially in sub-Saharan Africa. Malaria burden has steadily been declining in endemic countries due to progress made in scaling up of such important interventions. Objectives: The study assessed malaria health seeking practices for children under five years of age, and IPTp in Wakiso district, Uganda. Methods: A structured questionnaire was used to collect data from 727 households. Chi-square and Fisher’s exact tests were performed in STATA to ascertain factors associated with the place where treatment for children with suspected malaria was first sought (government versus private facility) and uptake of IPTp. Results: Among caretakers of children with suspected malaria, 69.8% sought care on the day of onset of symptoms. The place where treatment was first sought for the children (government versus ...

Wellcome Open Research, 2022

In sub-Saharan Africa (sSA), there is high morbidity and mortality from severe bacterial infectio... more In sub-Saharan Africa (sSA), there is high morbidity and mortality from severe bacterial infection and this is compounded by antimicrobial resistance, in particular, resistance to 3rd-generation cephalosporins. This resistance is typically mediated by extended-spectrum beta lactamases (ESBLs). To interrupt ESBL transmission it will be important to investigate how human behaviour, water, sanitation, and hygiene (WASH) practices, environmental contamination, and antibiotic usage in both urban and rural settings interact to contribute to transmission of ESBL E. coli and ESBL K. pneumoniae between humans, animals, and the environment. Here we present the protocol for the Drivers of Resistance in Uganda and Malawi (DRUM) Consortium, in which we will collect demographic, geospatial, clinical, animal husbandry and WASH data from a total of 400 households in Uganda and Malawi. Longitudinal human, animal and environmental sampling at each household will be used to isolate ESBL E. coli and ES...

Background: Initiating antenatal care within the first trimester and making at least four visits ... more Background: Initiating antenatal care within the first trimester and making at least four visits during pregnancy are recommended to enable screening and support for healthy lifestyles, well-being, and self-care in pregnancy. Due to glaring evidence on inequalities in access to antenatal care, this study assessed the effect of engaging community health structures on utilization of antenatal care services during pregnancy in resource-constrained rural settings in Uganda. Methods: A quasi-experimental evaluation study was conducted among mothers in Eastern Uganda. The intervention components included community dialogues and empowering community health workers to sensitize expectant mothers on the use of maternal health services, and health facility strengthening. The primary outcomes were early initiation of antenatal care and completion of at least 4 ANC visits. We used Difference in Differences (DiD) analysis and multivariate regression to assess the effect of the intervention on AN...

Journal of Pharmaceutical Policy and Practice, 2021

Background Inappropriate use of antimicrobials in both humans and animals is a key driver of anti... more Background Inappropriate use of antimicrobials in both humans and animals is a key driver of antimicrobial resistance (AMR). In addition, human behaviours such as poor disposal of antimicrobials in the environment can increase their exposure to microbes which can impact on humans and animals. However, evidence on access, use and disposal of antimicrobials for humans and animals at community level in Uganda is limited. This study therefore explored access, use and disposal of antimicrobials among humans and animals in Wakiso district, Uganda. Methods A qualitative study was conducted that involved focus group discussions (FGDs) and key informant interviews (KIIs). Participants of the FGDs were community health workers (CHWs) and farmers involved in animal husbandry, while key informants included: officials from the Ministry of Health; Ministry of Agriculture, Animal Industry and Fisheries; human and animal health professionals; district health officials; and members of the national A...

BMJ Global Health, 2020

Provenance and peer review Not commissioned; externally peer reviewed. Data availability statemen... more Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement All data relevant to the study are included in the article.

Environmental Health and Preventive Medicine, 2021

Antimicrobial resistance (AMR) is increasingly becoming a threat to global public health, not lea... more Antimicrobial resistance (AMR) is increasingly becoming a threat to global public health, not least in low- and middle-income countries (LMICs) where it is contributing to longer treatment for illnesses, use of higher generation drugs, more expenditure on antimicrobials, and increased deaths attributed to what should be treatable diseases. Some of the known causes of AMR include misuse and overuse of antimicrobials in both humans and animals, unnecessary use of antimicrobials in animals as growth promoters, and lack of awareness among the public on how to protect antimicrobials. As a result, resistant organisms are circulating in the wider environment, and there is a need to consider the One Health approach to minimise the continuing development of AMR. Environmental Health, specifically water, sanitation and hygiene (WASH), waste management, and food hygiene and safety, are key components of One Health needed to prevent the spread of antimicrobial-resistant microorganisms particula...