Primary studies included in this systematic review

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Immunisation coverage among children born to HIV-infected women in Rakai district, Uganda: effect of voluntary testing and counselling (VCT)

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Journal AIDS Care
Year 2006
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To evaluate the impact of maternal HIV-infection on routine childhood Immunisation coverage, we compared the Immunisation status of children born to HIV-infected and HIV-uninfected women in rural Uganda. The study population was 214 HIV(+) and 578 HIV(−) women with children aged 6 to 35 months previously enrolled in a community study to evaluate maternal and child health in Rakai District, Uganda. Sampling of subjects for interview was stratified by the use of voluntary counselling and testing (VCT) service so that the final sample was four groups: HIV + /VCT+ (n = 98); HIV + /VCT− (n = 116); HIV − /VCT+ (n= 348); HIV − /VCT− (n = 230). The main outcome measure was the percent of complete routine childhood Immunisations recommended by the WHO as assessed from Immunisation cards or maternal recall during household interviews. We found that Immunisation coverage in the overall sample was 26.1%. For all vaccines, children born to HIV-infected mothers had lower Immunisation coverage than children born to HIV-negative mothers (21.3 vs. 27.7%). There was a statistically significant interaction between maternal HIV-infection and maternal knowledge of HIV-infection (p = 0.034). The children of mothers who were HIV-infected and knew their serostatus (HIV + /VCT + ) had a more than two-fold odds of underImmunisation (OR = 2.21, 95% CI: 1.14, 4.29) compared to children of mothers who were HIV − /VCT−. We conclude that maternal HIV-infection was associated with childhood underImmunisation and this was mediated by a mother's knowledge of her HIV status. HIV VCT programmes should encourage HIV-infected mothers to complete childhood Immunisation. Improving access to Immunisation services could benefit vulnerable populations such as children born to HIV-infected mothers.

Primary study

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Birth plans and health facility based delivery in rural Uganda.

Journal East African medical journal
Year 2006
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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OBJECTIVES: To evaluate whether the completion of birth plans is associated with delivery in a health facility and the perceptual causes of birth plan completion and health facility based delivery were explored according to a well-tested health behaviour theory. DESIGN: A community survey. SETTING: Rakai and Luwero districts. SUBJECTS: A total of 415 (202 in Rakai and 213 in Luwero district) respondents were randomly selected and interviewed using a mixed survey questionnaire composed of open and close-ended questions. MAIN OUTCOME MEASURES: Health facility based delivery. RESULTS: The results demonstrate a statistically significant relationship between the completion of birth plans and delivery in a health facility (OR = 1.86, 95% CI =1.1, 3.1). The fear of consequences of delivering at home was found to be an important driving force in promoting the completion of birth plans, thereby indirectly influencing the likelihood of delivery in a health facility. CONCLUSION: Given the empirical evidence presented here, this study suggests that birth plans are an important tool in improving the rate of health facility based deliveries and thus essential in the fight against maternal mortality in Uganda. It is further recommended that campaigns market the use of birth plans as a way to reduce uncertainty and manage fear and the unknown about pregnancy.

Primary study

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Prevalence of sexually transmitted infections among adolescents in Kampala, Uganda, and theoretical models for improving syndromic management.

Journal The Journal of adolescent health : official publication of the Society for Adolescent Medicine
Year 2006
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PURPOSE: To estimate the prevalence of treatable sexually transmitted infections (STI) in adolescents visiting a youth health clinic. To evaluate the algorithm for management of the abnormal vaginal discharge (AVD) syndrome recommended in Uganda's national guidelines and compare it with other theoretical flowchart models. METHODS: Sexually experienced adolescents who were visiting an urban youth health clinic in Kampala, Uganda were examined and interviewed (with their consent) about their socio-demographic background, sexual risk factors, and genital symptoms. Samples taken for Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG), and Trichomonas vaginalis (TV) were analyzed by polymerase chain reaction (PCR). Rapid plasma reagin (RPR) was used with confirming treponema pallidum hem agglutination (TPHA) for syphilis diagnosis. One hundred ninety-nine females and 107 males were examined. Performance of the national algorithm was compared with different theoretical algorithms. RESULTS: Prevalence of CT, NG, TV and syphilis was 4.5%, 9.0%, 8.0%, and 4.0%, respectively, for girls and 4.7%, 5.7%, 0%, and 2.8%, respectively, for boys. We found that 20.6% of the females and 13.2% of the males had at least one STI. The national AVD flow chart had a sensitivity of 61%, a specificity of 38.5% and a positive predictive value (PPV) of 11.6%. All the models had PPV of less than 20% and sensitivity less than 85%. The best performing algorithm using risk and protective factors, rather than symptoms, implicated a sensitivity/specificity and PPV of 82.6%/47% and 17.3%, respectively (p = .012). CONCLUSIONS: An algorithm for management of STI using behavioral and demographic factors in this population demonstrated enhanced sensitivity, specificity, and PPV.

Primary study

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Mothers' education but not fathers' education, household assets or land ownership is the best predictor of child health inequalities in rural Uganda.

Journal International journal for equity in health
Year 2004
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND: Health and nutrition inequality is a result of a complex web of factors that include socio-economic inequalities. Various socio-economic indicators exist however some do not accurately predict inequalities in children. Others are not intervention feasible. OBJECTIVE: To examine the association of four socio-economic indicators namely: mothers' education, fathers' education, household asset index, and land ownership with growth stunting, which is used as a proxy for health and nutrition inequalities among infants and young children. METHODS: This was a cross-sectional survey conducted in the rural district of Hoima, Uganda. Two-stage cluster sampling design was used to obtain 720 child/mother pairs. Information on indicators of household socio-economic status and child anthropometry was gathered by administering a structured questionnaire to mothers in their home settings. Regression modelling was used to determine the association of socio-economic indicators with stunting. RESULTS: One hundred seventy two (25%) of the studied children were stunted, of which 105 (61%) were boys (p < 0.001). Bivariate analysis indicated a higher prevalence of stunting among children of: non-educated mothers compared to mothers educated above primary school (odds ratio (OR) 2.5, 95% confidence interval (CI) 1.4-4.4); non-educated fathers compared to fathers educated above secondary school (OR 1.7, 95% CI 0.8-3.5); households belonging in the "poorest" quintile for the asset index compared to the "least poor" quintile (OR 2.1, 95% CI 1.2-3.7); Land ownership exhibited no differentials with stunting. Simultaneously adjusting all socio-economic indicators in conditional regression analysis left mothers' education as the only independent predictor of stunting with children of non-educated mothers significantly more likely to be stunted compared to those of mothers educated above primary school (OR 2.1, 95% CI 1.1-3.9). More boys than girls were significantly stunted in poorer than wealthier socio-economic strata. CONCLUSIONS: Of four socio-economic indicators, mothers' education is the best predictor for health and nutrition inequalities among infants and young children in rural Uganda. This suggests a need for appropriate formal education of the girl child aimed at promoting child health and nutrition. The finding that boys are adversely affected by poverty more than their female counterparts corroborates evidence from previous studies.

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Health inequality in Uganda — the role of financial and non-financial barriers

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Authors Odaga, John
Journal Health Policy and Development
Year 2004
Links bioline.org.br Google Scholar

This article is included in 1 Systematic review Systematic reviews (1 reference)

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Inequality in health is known to be rampant among different socio-economic groups, with the poor typically suffering more ill-health and facing greater economic cost of ill-health than the rich. Yet a number of other non-economic factors are also known to concurrently operate, in a complex way, to further ration healthcare in favour of the rich. Measuring, monitoring and understanding the influences these factors pose in determining health-seeking behaviour at district and sub district levels are necessary to guide policy. Policies based on intuition alone can be misleading. The household survey was an attempt to understand the level and direction of disparities in health by socio-economic differentials in Uganda; and the roles of both financial and non barriers to healthcare use. A total of 843 households were sampled (by probability proportionate to size technique) from four health sub districts. We found that the poorest quintiles were 2.4 times more likely to suffer ill-health than the richest quintiles, with a greater proportion of them lacking access to publicly-provided health services than the richest counter-parts. There were no rich-poor differences in the types of illnesses/injuries. Although the findings of this survey confirm the conventional wisdom, they also reveal healthcare use patterns that reflect, not only the importance of financial barriers, but also the opportunity costs in travel (and possibly waiting) time, and other important factors including the availability, affordability and the perceived quality of services.

Primary study

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Coping with paediatric referral—Ugandan parents' experience

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Journal The Lancet
Year 2004
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Referral of severely ill children to hospital is key in the Integrated Management of Childhood Illness (IMCI). In rural Uganda, we documented the caretakers' ability to complete referral to hospital from 12 health facilities. Of 227 children, only 63 (28%) had completed referral after 2 weeks, at a median cost of US$8.85 (range 0.40–89.00). Failure to attend hospital resulted from lack of money (139 children, 90%), transport problems (39, 26%), and responsibilities at home (26, 17%). Children with incomplete referral continued treatment at referring health centres (87, 54%) or in the private sector (45, 28%). Our results show that cost of referral must decrease to make paediatric referral realistic. When referral is difficult, more specific IMCI referral criteria should be used and first-level health workers should be empowered to manage severely ill children.

Primary study

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Maternal mortality and associated near-misses among emergency intrapartum obstetric referrals in Mulago Hospital, Kampala, Uganda.

Authors Kaye D , Mirembe F , Aziga F , Namulema B
Journal East African medical journal
Year 2003
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BACKGROUND: Many maternal deaths (as well as related severe morbidity) are of women who do not attend antenatal care in a given health unit but are referred there when they develop life-threatening obstetric complications. OBJECTIVE: To determine the reproductive characteristics of emergency obstetric referrals, and determine the contribution of emergency obstetric referrals to severe acute maternal morbidity (near-misses) and maternal mortality. STUDY DESIGN: Descriptive cross-sectional study. SETTING: Mulago hospital, the National Referral hospital, Kampala, Uganda, from 1st March to August 30th 2000. SUBJECTS: Nine hundred and eighty three consecutive women admitted as emergency obstetric referrals in labour or puerperium. INTERVENTIONS: Subjects were followed from time of admission to discharge (or death). They were interviewed (or examined) to obtain data on socio-demographic characteristics, reproductive history, obstetric outcome of the index pregnancy, obstetric complications and cause of death. Their records were reviewed to determine evidence of severe acute morbidity from acute organ/system dysfunction, using the definition by Mantel et al. These data were analysed using the Epilnfo computer programme in terms of means, frequencies and percentages. MAIN OUTCOME MEASURES: Socio-demographic characteristics, obstetric complications, cause of deaths, cause and type of near miss mortality and case fatality rates. RESULTS: Of the 983 referrals, over 100 were near-misses and 17 died. Using the definition of Mantel et al of near-misses enabled identification of six times as many near-misses as maternal deaths. The commonest causes of death were postpartum haemorrhage and eclampsia. Low status was highly associated with both maternal deaths and near misses. CONCLUSION: In developing countries, with poor obstetric services, emergency transfers in labour are very common. These women, who are of low status, contribute significantly to maternal mortality and morbidity.

Primary study

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Prevalence of childhood illnesses and care-seeking practices in rural Uganda.

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Authors Mbonye, Anthony K.
Journal The Scientific World Journal
Year 2003
Links Pubmed DOI PubMed Central

This article is included in 1 Systematic review Systematic reviews (1 reference)

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There is a declining trend of child health indicators in Uganda despite intensified program efforts to improve child care. For example, the infant mortality rate increased from 81/1,000 in 1995 to 88/1,000 in the year 2000. This paper presents results of a study that assessed factors responsible for this trend. The objectives were to assess the prevalence of childhood illnesses and care-seeking practices for children with fever, diarrhea, and upper respiratory tract infections (URTI) in the Sembabule district of Central Uganda. A cross-sectional survey, using a WHO 30 cluster-sampling technique, was used to obtain data from 300 women with children aged less than 2 years. Prevalence of childhood illnesses and care-seeking practices were obtained using a structured questionnaire supplemented by in-depth interviews. The results showed that the 300 women interviewed had 323 children of whom 37.9% had an episode of fever 2 weeks before the survey, 40.3% had diarrhea, 37.4% had URTI, and 26.8% were fully immunized. Most of the women, 82.7%, perceived fever as the most serious health problem to their children. URTI, diarrhea, and measles were perceived as serious by a lower proportion of women. Although this study showed high perceptions of childhood diseases, the proportion of mothers seeking care for sick children was low, indicating that there are barriers to accessing care. For example, 44.7% of women sought care when their children had fever, 35.0% when children had URTI, and 31.3% when children had diarrhea. However, most children with fever, diarrhea, and URTI were treated at home and taken to health units only when they developed life-threatening symptoms. This late referral to health units was complicated by high costs of care, long distances to health units, poor attitude of health workers, lack of drugs at health units, and limited involvement of fathers in care of the children. The results of this study showed that although the perceptions of childhood diseases were high, the care-seeking practices were poor. In order to improve child care in this district, there is a need to address barriers to quality of care and to conduct further research to assess the role of cultural factors and male involvement in child care.

Primary study

Unclassified

Factors influencing acceptability of voluntary counselling and testing for HIV in Bushenyi district of Uganda.

Journal East African medical journal
Year 2002
Links Pubmed DOI PubMed Central

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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OBJECTIVE: To understand the factors influencing choice of voluntary counselling and testing (VCT) for HIV with a view of suggesting measures for increased uptake. DESIGN: Focus group discussions were used to elicit reasons for carrying out VCT and a cross sectional survey to estimate the proportion of people who undertake VCT. SETTING: Bushenyi district, Uganda. PARTICIPANTS: A cluster random sample of 219 people and four purposively selected focus group discussions with 32 participants. MAIN OUTCOME MEASURES: Elicited attitudinal beliefs, self-efficacy expectations, and social influences that are probably associated with VCT for HIV based on the Attitude Social influence self-Efficacy (ASE) Model. The proportion of people who had ever undertaken VCT for HIV was also determined. RESULTS: Thirty-eight (17%) of the 219 people interviewed had ever undergone HIV. The factors influencing VCT for HIV were consequences of a test result, influences from a sexual partner, cost of VCT, physical accessibility of VCT, awareness, risk of HIV infection, need for linking VCT with care (especially availability of anti-retrovirals) and perceived quality of care of VCT services. CONCLUSIONS: Increased mobilisation and access for VCT, reducing costs of VCT, linking of VCT with care, and emphasising the positive consequences of VCT as well as providing high quality VCT services may increase the number of people seeking VCT.

Primary study

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Generalizability of population-based studies on AIDS: a comparison of newly and continuously surveyed villages in rural southwest Uganda.

Journal International journal of epidemiology
Year 2002
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND: Population-based studies are thought to provide generalizable epidemiological data on the human immunodeficiency virus type 1 (HIV-1) epidemic. However, longitudinal studies are susceptible to bias from added attention caused by study activities. We compare HIV-1 prevalence in previously and newly surveyed villages in rural southwest Uganda. METHODS: The study population resided in 25 neighbouring villages, of which 15 have been surveyed for 10 years. Respondents (>/=13 years) provided socio-demographic and sexual behaviour data and a blood sample for HIV-1 serology in private after informed consent. We tested the independent effect of residency: (1) original versus new villages; (2) proximity to main road; and (3) proximity to trading centre on HIV-1 serostatus of respondents using multivariate logistic regression. RESULTS: There were 8,990 adults censused, 68.3% were from the original villages, 48.2% were males and 6111 (68.0%) were interviewed and had definite HIV-1 serostatus. The HIV-1 prevalence was 6.1% overall, 5.7% in the new, and 6.4% in the original villages (P = 0.25). Residency in the new or original villages did not independently predict HIV-1 serostatus of respondents (P = 0.46). Independent predictors of HIV-1 serostatus were education (primary or higher, odds ratio [OR] = 1.7 and 1.4, respectively), being separated or widowed OR = 4.2, reported previous use of a condom OR = 1.8, or reported genital ulceration OR = 3.3, and age group 25-34 and 35-44 years OR = 5.8 and OR = 4.8 (all P </= 0.001). CONCLUSIONS: In the context of rural Uganda where there has been considerable health education about AIDS, the additional attention to HIV infection caused by this longitudinal study does not appear to have appreciably affected the prevalence of HIV-1 infection.