Department of Environmental Health and Disease Control

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    Factors influencing consistent use of bed nets for the control of malaria among children under 5 years in Soroti District, North Eastern Uganda
    (Malaria Journal, 2022) Akello, Anne Ruth; Byagamy, John Paul; Etajak, Samuel; Okadhi, Charles Stephen; Yeka, Adoke
    Background: The use of insecticide-treated bed nets has been proven to be effective in reducing malaria transmission in highly endemic areas. Use of long-lasting insecticidal nets (LLINs) has been embraced by many malaria endemic countries. LLINs are up to 95% effective in inhibiting blood feeding, when used consistently even after 7 years. The challenge, however, is enhancing their consistent use, especially by the most vulnerable groups (children under 5 years and pregnant women). The study established factors associated with consistent use of bed nets for malaria control among children under 5 years in Soroti district. Methods: The study employed a cross-sectional design, with multi-stage sampling of households. A total of 400 households (HH) were sampled and the HH head in each household interviewed. Key informant interviews (KIIs) were conducted with 7 key informants who were knowledgeable on the subject matter. Data analysis was done using SPSS 17.0 at Univariate, Bivariate and Multivariable levels; after entry and cleaning. Key informants’ data were summarized manually; verbatim quotes and text used to reinforce quantitative data in line with objectives. Results: Only 56.8% of the 690 children under 5 years used bed nets consistently. The factors affecting consistent bed net use were age of the child, their use of bed nets the previous night, occupation of caretaker, respondents’ perceived susceptibility, perceived risk of getting malaria, size and shape of the bed nets. Rectangular nets were difficult to hang daily in huts according to most key informants. Conclusion: Consistent bed net use among under fives is still below the RBM target of 85% by 2015 and can be enhanced by providing conical bed nets and setting aside a health education programme to emphasize the effectiveness of even one mosquito in spreading malaria at night to the entire household and ability of bed nets to stop transmission better than other methods.
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    Prevalence and Determinants of Asymptomatic Malaria Among Pregnant Women Attending Primary Health Care Services in Lira District / Lira City
    (Lira University, 2022) Acio, Harriet Sarah; Omech, Bernard; Oceng, Freda Amito
    Background: Asymptomatic malaria infection is a positive Rapid Diagnostic Test or blood smear for P. falciparum with no clinical signs or symptoms conclusive of Malaria. Most malaria infections among pregnant women in high or moderate transmission are asymptomatic, infected women may not seek treatment yet with a devastating consequences on both the mother and fetus and can progress to severe MIP by acting as reservoir of malaria infection. Objectives To assess the prevalence and determinants of asymptomatic Malaria among pregnant women attending services in PHC facilties in lira district/Lira City. Methods: The study used a descriptive cross-sectional design. Data was collected using a semi-structured questionnaire administered to pregnant women tested for asymptomatic MIP at their exit points. Analysised at three levels univariate, bivariate and multivariate respectively. Variables with p-values ˂0.05 were considered statistically significant factors influencing Asymtomatpic MIP on logistic regression. While qualitative data collected through key informat interview guide, analysised through content analysis. Results: Of the 267 respondents, 25.5% had asymptomatic malaria, living within Lira district (aOR=0.50,p=0.02,95% Cl=0.276-0.895) had a 50% incresed likilhood of asymptomatic MIP compared to living in Lira City, being aged 25-29 years (aOR=2.70, ,p=0.04,95% Cl=1.067-6.82) had a 2.70 odds of asymptomatic MIP compared to other age groups. Women from places where VHTs did,t know their roles (aOR=0.596, ,p=0.01,95% Cl=0.322-1.10) had a 0.4% incresed likilhood of asymptomatic MIP compared to others. Conclusion: High prevalence of asymptomatic malaria in Lira district compared to Lira City. Middle age mother were more than twice more likely to have assymptomic malaria.
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    Cost effectiveness Analysis of adding Tuberculosis Household Contact Investigation on Passive Case Finding Strategy in Southwestern Uganda.
    (Lira University, 2022) Odongo, Dickens; Omech, Bernard; Acanga, Alfred
    Background: The standard passive case-finding strategy implemented by most developing countries is inadequate to detect new cases of TB. A household contact investigation is an alternative approach. The study aimed to evaluate the cost-effectiveness of adding household contact investigation (HHCI) to passive case-findings (PCF)strategy in the Tuberculosis control program in south western Uganda. Methods: The study utilized decision-analytic modelling and bottom-up costing (ingredients) methods. The study obtained cost and ability and probability estimates on from national TB program data, activity costs, publicized literature, and expert opinions. It was performed from the societal and provider perspectives over 1.5 years across 12 facilities in Ntuganu, Sheema, and Rwampara Districts. The primary effectiveness measure was the number of actual TB cases detected (yield) and the number needed to screen (NNS). The TB yield was calculated from the number of patients diagnosed over the screen. The incremental cost-effectiveness ratio (ICER) was expressed as cost in 2021 US$ per additional TB case detected. Results: The TB screening yields were 0.52% (1496/289140) for HHCI and 5.8% (197/3414) for PCF. HHCI yield among children 0-14 Vs. 15+ years [6.2% Vs.5.4%] P=0.04. The yield among PLHIV Vs. HIV-negative [15.8% Vs. 5.3%] P=0.03 in HHCI. The PCF yield in men Vs. women [1.12% Vs. 0.28%] P<0.01. The NNS in PCF was 193 [95% CI: 186-294] and 17 [95% CI: 14-22] in HHCI. The unit costs of detecting a TB case were US$ 204.22 for PCF and US$ 315.07 for HHCI. Patient and caregiver cost are five times in PCF than HHCI [US$ 26.37 Vs.US$ 5.42]. Under the study baseline assumption, adding HHCI to PCF strategies was not cost effectives at US$ 3,596.94 per additional case detected. Conclusion: HHCI improves access to TB diagnosis in children 0.14 years and PLHIV; however, PCF improves access to TB diagnosis among men. The unit cost of detecting one TB case in HHCI was higher than in PCP. Adding HHCI to PCF was not cost effective for detecting TB compared to PCF alone. Therefore, PCF remains the ideal and cost-effective strategy for low- resource countries like Uganda. Keywords: Cost-effectiveness, Yield, NNS, Tuberculosis, Household contact investigation, Passive case Findings, South western Uganda.
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    Ebola Epidemic Preventive Practices: Knowledge, Attitude and Practice of Community Members in High-Risk Districts of Uganda
    (Journal of Infectious Diseases and Medicine, 2023) Kigongo*, Eustes; Auma, Ann Grace; Tumwesigye, Raymond; Namukwana, Beth; Musinguzi, Marvin; Okalo, Ponsiano; Kambugu, Caroline Nabasiry; Kabunga, Amir
    Background: As part of the country's ongoing EVD outbreak preparedness activities in Uganda, our goal was to evaluate community knowledge and attitudes and preventive practices linked to the disease. Methods: This study employed a community-based cores sectional study among 842 participants. The study was conducted in three districts of Mubende, Kyegegwa and Kassanda in the central region of Uganda. These are high-risk districts in Uganda Results: Results show that the majority 290(34.4%) of the participants were aged between 28–38 years, 578(68.6%) were female, 482(57.2%) had primary education, 431(51.2) single, 369(44.7) unemployed and 196(23.8) received information from radios. Results indicate that 821(97.5%) of the participants had heard of EVD, and 646(76.7%) reported that EVD is a rare and deadly disease. On the mode of transmission, 562(66.7%) knew that EVD is transmitted through physical contact with an infected person, 498(59.1%) through blood and 606(72.0%) through normal social contact. Overall, 525 respondents were classified as having good knowledge of the Ebola virus disease, accounting for 62.4% of the total, whereas 470(55.8%) had a favorable attitude toward the management and prevention of the Ebola virus disease. A greater understanding of the Ebola virus disease was found among participants with increased age and education beyond the first grade compared to those with no formal education. Casual labourers were 3 times more likely to have good practices compared to agriculturalists. Participants who received information from others sources were less likely to have good practices compared to those who received it from the radio. Conclusion: Communities in Uganda impacted by filovirus outbreaks have a reasonable level of knowledge and a favourable attitude toward methods to prevent and control the Ebola disease. Public health officials should do more by providing instructional materials for future epidemic preparedness utilizing appropriate communication channels, especially, including local radios as reported by the communities. Keywords: Attitude • Ebola virus • Infection • Knowledge • Prevention
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    COVID-19 vaccination hesitancy and associated factors among the business community in Lira City, Uganda: a cross-sectional research
    (2023) Eustes, Kigongo; Everlyne, Achan; Amir, Kabunga; Sean Steven, Puleh
    Background: As of November 26th, 2021, three platforms and at least seven distinct vaccines had been delivered worldwide. The vaccines include: Pfizer/BioNTech on December 31, 2020; AstraZeneca on February 16, 2021; Janssen by Johnson & Johnson on March 12, 2021; Moderna on April 30, 2021; Sinopharm on May 7, 2021; Sinovac CoronaVac on July 1, 2021; and COVAXIN on November 3, 2021. Despite this ground-breaking scientific finding, vaccine reluctance is considered as a barrier to obtaining herd immunity in the fight to contain this widespread pandemic. The idea that the population was willing to accept the vaccination in order to create herd immunity has been the foundation for the effectiveness of vaccines. The goal of this study was to assess COVID-19 vaccination hesitancy and associated factors among the business community in Lira City, Uganda. Methods: Descriptive cross-sectional design. Conducted among members of the business community from Lira City in Northern Uganda. The sample size was 421, however, only 407 members of the business community who responded were included in the analysis. Results: Of the 407 participants, 57.3% were females, 52.5% were married, 88.4% were Langi by Tribe, 43.5% had tertiary education, 33.4% were Anglicans, and 40.1% were market vendors. Results also show that about 32.3% of the respondents had either delayed or refused to take the COVID-19 vaccine. The correlates of vaccination hesitance were education level (aOR; 3.63, 95%CI; 1.49-8.79, p=0.04), having a chronic medical condition (aOR; 2.7, 95%CI; 1.39-5.38, p=0.04) and certainty in the COVID-19 vaccines (aOR; 0.27, 95%CI; 0.017-0.51, p=0.02). Respondents who had primary level education had a more than 2-fold increased odds of acceptance of COVID-19 vaccination compared to those who had not attained any formal education. Individuals who had chronic medical conditions had more than 2-fold increased odds of accepting the COVID-19 vaccine compared to those who did not have any chronic medical conditions. Those who were certain in COVID-19 vaccine were 73% less likely to hesitate vaccination as compared to their counterparts who were uncertain. Conclusion: The study found a substantially high level of COVID-19 vaccination hesitancy in Lira city and its predictors were level of education, chronic medical conditions and certainty in COVID-19 vaccines. For this reason, it is important to raise awareness among the business community about the vaccine. To increase uptake, policymakers and other stakeholders need to create effective communication techniques for behavior change.
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    Prevalence and predictors of COVID-19 vaccination hesitancy among healthcare workers in Sub-Saharan Africa: A systematic review and meta-analysis
    (PLOS ONE, 2023) Kigongo, Eustes; Kabunga, Amir; Tumwesigye, Raymond; Musinguzi, Marvin; Izaruku, Ronald; Acup, Walter
    Background The COVID-19 vaccination is regarded as an effective intervention for controlling the pan demic. However, COVID-19 vaccine hesitancy is hampering efforts geared towards reduc ing the burden of the pandemic. Therefore, examining COVID-19 hesitancy and its predictors among healthcare workers is essential to improving COVID-19 uptake. In sub Saharan Africa, the pooled proportion of COVID-19 vaccine hesitancy is yet to be known. Purpose The present study was to estimate the pooled proportion of COVID-19 vaccine hesitancy and its predictors among healthcare workers in Sub-Saharan Africa. Methods A systematic search of articles was conducted in PubMed, Science Direct, African Journal Online, and Google Scholar. Data was extracted with the help of Excel. Data analysis was conducted using STATA 17. Heterogeneity in the studies was assessed using Cochrane Q and 12 tests. A random effects model was used to examine the pooled estimates to deter mine if heterogeneity was exhibited. Results A total of 15 studies involving 7498 participants were included in the final analysis. The pooled prevalence of COVID-19 vaccination hesitancy among healthcare workers was 46%, 95% CI (0.38–0.54). The predictors of COVID-19 hesitancy were negative beliefs towards vaccine 14.0% (OR = 1.05, 95% CI: 1.04, 1.06), perceived low risk of COVID-19 infection 24.0% (OR = 1.25, 95% CI: 1.23, 1.28), and vaccine side effects 25.0% (OR = 1.23, 95% CI: 1.21, 1.24). Conclusion The data revealed generally high hesitancy of COVID-19 vaccine among health workers in Sub-Saharan Africa. Future COVID-19 adoption and uptake should be improved by national and individual level efforts. In Sub-Saharan Africa, it is crucial to address the myths and obstacles preventing healthcare professionals from accepting the COVID-19 vaccination as soon as feasible since their willingness to get the vaccine serves as an important example for the broader public.
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    Nursing Documentation Practices and Related Factors in Patient Care in Ethiopia: A Systematic Review and Meta-Analysis
    (Hindawi, 2023) Hardido, Temesgen Geta; Kedida, Beimnet Desalegn; Kigongo, Eustes
    professional e1ciency. On the prevalence of nurses’ documentation practices in Ethiopia, several separate studies have been carried out. However, there is no pooled prevalence of nurses’ documentation practice. ,erefore, this systematic review and meta-analysis aimed to assess the overall prevalence of nursing care documentation practice and related factors in Ethiopia. Methods and Materials. ,is review only included articles that were published.,emain databases were Medline/PubMed, Web of Science, Google Scholar, Scopus, Ethiopian University Repository Online, and the Cochrane Library. Cross-sectional studies that satisfy the criteria and are written in English are included in the review. Using a random e0ects model, the pooled prevalence of nurses’ documentation practices was determined. ,e funnel plot and the Eggers test were also used to look into publication bias. All statistical analyses were done with STATA version 14. Result. ,is review included nine studies with a total of 2,900 participants. ,e pooled prevalence of nurses’ documentation practice in Ethiopia was 50.01% (95% CI: 42.59 and 57.18; I2 � 93.8%; and P 0.001). In terms of subgroup analysis, Addis Ababa had the highest prevalence of nurses’ documentation practice at 84% (95% CI: 77.18 and 90.82), while Southern Ethiopia had the lowest at 40.00% (95% CI: 38.10 and 44.90). Nursing documentation practices were statistically associated with the availability of nursing documentation formats, adequate nurse-topatient ratio, motivation, and training. Conclusion. ,is review showed that one in two nurses practiced poor documentation of their daily activities in Ethiopia. ,erefore, strict monitoring, evaluation, and supervision of nursing care documentation services are highly recommended for all stakeholders. We strongly recommend improving the identiAed factors by arranging training for nurses, motivating them, providing adequate documentation formats, and maintaining a nurse-to-patient ratio.
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    Factors associated with Occupational injuries amongst solid waste handlers in Mbale City.
    (Lira University., 2023) Mwanga, Issa; Akello, Anne Ruth
    Background: Universally, occupational injuries are responsible for 15%of the deaths associated to occupational accidents. The work done by solid waste handlers exposes them to frequent occupational hazards which results in several injuries among them. The increase of work-related injuries from 43.7% to 63.9% among solid waste handlers in sub-Saharan Africa calls for more studies to be carried out. The objectives of this study was to assess the level of occupational injuries and associated factors amongst solid waste Handlers in Mbale City. Study methods: This was a cross- sectional design which employed mixed methods. Row data was collected using semi-structured questionnaires. Quantitative data was captured, cleaned and analyzed using SPSS version 20.0 at Univariate, Bivariate & Multivariate levels. Results: Occupational injuries level amongst solid waste handlers was 70.83% (85/120). Factors that were associated to this injury level included; No education (AOR 1.42; 95% C1=1.04-1.93), primary education (AOR: 1.49; 95% cI:1.00-2.24) and sharing protective clothing (AOR 1.58% CI =1.17-2.14). Findings: The study finding showed that the level of occupational injuries amongst solid waste handlers in Mbale City was greater as likened to that found by comparable research conducted in Tanzania, Ghana , Ethiopia and Egypt. The factors associated to occupational injuries level in this study includes; education, and sharing protective clothing. City Medical Officer of Health and policy makers should ensure provision of PPES to solid waste handlers, pre-employment screening and ensure waste handlers completed post primary education Conclusion: Occupational; injuries level amongst solid waste handlers at Mbale city was high at 70.83% Keywords: Occupational Injuries, solid waste, solid waste handlers
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    The Lived Experiences of Individuals and Coping Strategies in the Context of Internet Gaming Disorder: A Qualitative Study Within Higher Education Setting in Uganda
    (Neuropsychiatric Disease and Treatment, 2024) Nalwoga, Viola; Kizito, Simon; Kigongo, Eustes; Atwine, Praise; Kabunga, Amir
    Background: Internet Gaming Disorder (IGD), recognized as a mental disorder in both the Diagnostic and Statistical Manual (DSM5) and International Classification of Diseases (ICD-11), poses significant threats to physical, social, and mental well-being. This study aims to delve into the experiences of individuals grappling with IGD. Methods and Materials: The study employed an interpretive phenomenology, conducting interviews with 10 graduate students at Makerere University. Participants were purposefully sampled until data saturation was achieved during interviews, which took place between May and July 2023. An interview guide facilitated data collection (Supplementary File 1), and thematic analysis was manually applied for data interpretation, utilizing intuition and imaginative approaches. Results: The findings revealed that the majority of participants started gaming during childhood, starting with offline games. Exposure to gadgets and games, idle time, and stress emerged as key triggers for IGD. Participants reported experiencing sleep deficits, deteriorating interpersonal relationships, declining job performance, unhealthy eating habits, academic challenges, and wastage of money and time. The study also identified strategies employed by participants to mitigate their gaming behaviors, such as refraining from purchasing data, seeking support from friends, and uninstalling the game app, although relapses were common. Conclusion: The study highlights a global pattern of early initiation into gaming, emphasizing the need for early intervention and preventive measures. Factors such as easy accessibility and affordability of gaming platforms, idleness, and stress play significant roles in motivating internet gaming, contributing to a higher prevalence among the studied population. The research underscores the adverse effects of IGD on students, affecting academic performance, interpersonal relationships, and job performance. Notably, participants demonstrate agency in addressing IGD through practical coping strategies, including controlling data access, seeking social support, and uninstalling games. These coping mechanisms provide valuable insights into the complex nature of addressing IGD and form a basis for developing targeted interventions and support systems within the higher education setting in Uganda. Keywords: internet gaming disorder, lived experiences, coping strategies, qualitative study, higher education setting