Department of Health Policy and Management

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Prevalence of HIV-AssociatedMetabolic Abnormalities among Patients Taking First-Line Antiretroviral Therapy in Uganda
(International Scholarly Research Network, 2012) Omech, Bernard; Sempa, Joseph; Castelnuovo, Barbara; Opio, Kenneth; Otim, Marcel; Mayanja-Kizza, Harriet; Colebunders, Robert; Manabe, Yukari C.
Introduction. While the introduction of highly active antiretroviral therapy decreased HIV-related morbidity and mortality rates in the sub-Saharan Africa, a subsequent increase in metabolic abnormalities has been observed. We sought to determine the prevalence of HIV-associated metabolic abnormalities among patients on first-line antiretroviral therapy (ART) in an ART clinic in Kampala, Uganda. Methods. Four hundred forty-two consecutive patients on first-line ART for at least 12 months were screened for eligibility in a cross-sectional study, and 423 were enrolled. Pre-ART patient characteristics were abstracted from medical charts, examinations included anthropometric measurement and physical assessment for lipodystrophy. Results. The prevalence of hyperglycemia and dyslipidemia was 16.3% (69/423) and 81.5% (345/423), respectively. Prevalence of dyslipidemia between stavudine- and zidovudine-based regimens (91% versus 72%; P < 0.001). Being on stavudine (aOR 4.79, 95%, 2.45–9.38) and peak body weight (aOR 1.44, 95% CI 1.05–1.97) were independent risk factors for dylipidemia. Stavudine (aOR 0.50, 95% CI 0.27–0.93) use was associated with lower risk for hyperglycemia while, and older age (aOR 1.31, 95% CI 1.11–1.56) and having a family history of DM (aOR 2.18, 95% CI 1.10–4.34) were independent risk factors for hyperglycemia. Conclusions. HIV-associated metabolic complications were prevalent among patients on thymidine analogue-containing ART regimens. Screening for lipid and glucose abnormalities should be considered in ART patients because of cardiovascular risks.
A case of Shapiro’s Syndrome in an African young man
(Case Reports in Internal Medicine, 2015) Chacha, Mwita Julius; Omech, Bernard; Keatlaretse, Siamisang; Humphrey, Bose
Shapiro’s syndrome is a rare congenital neurological disease characterized by episodes of excessive sweating and hypothermia, and by complete/partial agenesis of the corpus callosum. We report an 18 year-old male who was referred to Princess Marina Hopsital with a longstanding history of episodic shaking chills, excessive sweating, fatigue, and unsteady gait. During the episodes, he was bradycardic (pulse rate of less than 36 beats/minute), with blood pressure of less than 80/45 mmHg, and his axillary body temperatures were unrecordably low. Neurologic examination showed cerebellar signs. The MRI of the brain revealed agenesis of the corpus callosum with no other abnormalities. The patient responded to clonidine therapy. Shapiro’s syndrome is an important consideration when evaluating a patient with episodic hyperhidrosis and hypothermia. The syndrome is rare worldwide and to the best of our knowledge, this report constitutes the first documentation of a case from Africa.
Validity of the Finnish Diabetes Risk Score for Detecting Undiagnosed Type 2 Diabetes among General Medical Outpatients in Botswana
(ournal of diabetes research, 2016) Omech, Bernard; Mwita, Julius Chacha; Tshikuka, Jose-Gaby; Tsima, Billy; Nkomazna, Oathokwa; Amone-P’Olak, Kennedy
This was a cross-sectional study designed to assess the validity of the Finnish Diabetes Risk Score for detecting undiagnosed type 2 diabetes among general medical outpatients in Botswana. Participants aged ≥20 years without previously diagnosed diabetes were screened by (1) an 8-item Finnish diabetes risk assessment questionnaire and (2) Haemoglobin A1c test. Data from291 participants were analyzed (74.2% were females). The mean age of the participants was 50.1 (SD = ±11) years, and the prevalence of undiagnosed diabetes was 42 (14.4%) with no significant differences between the gender (20% versus 12.5%, 𝑃 = 0.26). The area under curve for detecting undiagnosed diabetes was 0.63 (95% CI 0.55–0.72) for the total population, 0.65 (95% CI: 0.56–0.75) for women, and 0.67 (95% CI: 0.52–0.83) formen.The optimal cut-off point for detecting undiagnosed diabetes was 17 (sensitivity = 48% and specificity = 73%) for the total population, 17 (sensitivity = 56% and specificity = 66%) for females, and 13 (sensitivity = 53% and specificity = 77%) for males.The positive predictive value and negative predictive value were 20% and 89.5%, respectively. The findings indicate that the Finnish questionnaire was only modestly effective in predicting undiagnosed diabetes among outpatients in Botswana.
Prevalence and determinants of metabolic syndrome: a cross-sectional survey of general medical outpatient clinics using National Cholesterol Education Program-Adult Treatment Panel III criteria in Botswana
(Dovepress, 2016) Omech, Bernard; Tshikuka, Jose-Gaby; Mwita, Julius C; Tsima, Billy; Nkomazana, Oathokwa; Amone-P’Olak, Kennedy
Background: Low- and middle-income countries, including Botswana, are facing rising prevalence of obesity and obesity-related cardiometabolic complications. Very little information is known about clustering of cardiovascular risk factors in the outpatient setting during routine visits. We aimed to assess the prevalence and identify the determinants of metabolic syndrome among the general outpatients’ attendances in Botswana. Methods: A cross-sectional study was conducted from August to October 2014 involving outpatients aged ≥20 years without diagnosis of diabetes mellitus. A precoded questionnaire was used to collect data on participants’ sociodemographics, risk factors, and anthropometric indices. Fasting blood samples were drawn and analyzed for glucose and lipid profile. Metabolic syndrome was assessed using National Cholesterol Education Program-Adult Treatment Panel III criteria. Results: In total, 291 participants were analyzed, of whom 216 (74.2%) were females. The mean age of the total population was 50.1 (±11) years. The overall prevalence of metabolic syndrome was 27.1% (n=79), with no significant difference between the sexes (female =29.6%, males =20%, P=0.11). A triad of central obesity, low high-density lipoprotein-cholesterol, and elevated blood pressure constituted the largest proportion (38 [13.1%]) of cases of metabolic syndrome, followed by a combination of low high-density lipoprotein, elevated triglycerides, central obesity, and elevated blood pressure, with 17 (5.8%) cases. Independent determinants of metabolic syndrome were antihypertensive use and increased waist circumference. Conclusion: Metabolic syndrome is highly prevalent in the general medical outpatients clinics. Proactive approaches are needed to screen and manage cases targeting its most important predictors.
The utilization of HbA1c test in the screening and diagnosis of type 2 diabetes mellitus: An outpatient clinics survey in Botswana
(Journal of Diabetes and Endocrinology, 2017) Omech, Bernard; Tshikuka, Jose-Gaby; Amone-P’Olak, Kennedy; Mwita, Julius; Tsima, Billy; Nkomazana, Oathokwa
This study aimed to assess HbA1c performance against single fasting blood glucose (FBG) for diagnosis of undiagnosed type 2 diabetes (T2D) and impaired fasting glycaemia (IFG) among general medical outpatients in Botswana. Participants aged, ≥20 years were cross-sectionally surveyed from August to October, 2014. All the participants underwent testing for HbA1c and FBG. The HbA1c sensitivity, specificity and predictive values in the diagnosis of T2D and IFG were computed and their Pearson’s correlation and scatter diagrams determined. A total of 291 participants (74.2% women) with a mean age of 50.1±11.0 years provided data for the current analysis. HbA1c at cut-off of ≥ 6.5% (48 mmol/mol) had a sensitivity and specificity for T2D of 100 (15.81 to 100.00) and 86.3% (86.16 to 89.92), respectively. Similarly, for IFG, the sensitivity and specificity was 100 (2.5 to 100) and 36.3% (30.3 to 42.6), respectively. The positive predictive value (PPV) was 4.8 (0.58 to 16.16) and 0.6% (0.02 to 3.45) for T2D and IFG screening, respectively. The negative predictive value (NPV) was 100% in both cases of T2D and IFG screening. HbA1c had a modest, positive correlation (r) with FBG for the overall population (r = 0.536, p < 0.001); for women, (r = 0 .578, p < 0.001) and men (r =0 .336, p =0.003). HbA1c had high sensitivity but widely varying specificity, high proportion of discordant results and poor prediction of T2D and IFG in this setting. Although, HbA1c correlation with fasting glucose was modest, both tests are required to improve diagnostic reliability in asymptomatic T2D screening program.
Presentation and mortality of patients hospitalised with acute heart failure in Botswana
(Cardiovascular journal of Africa, 2017) Mwita, Julius Chacha; Dewhurst, Matthew J; Magafu, Mgaywa GMD; Goepamang, Monkgogi; Omech, Bernard; Majuta, Koketso Lister; Gaenamong, Marea; Palai, Tommy Baboloki; Mosepele, Mosepele; Mashalla, Yohana
Introduction: Heart failure is a common cause of hospitalisation and therefore contributes to in-hospital outcomes such as mortality. In this study we describe patient characteristics and outcomes of acute heart failure (AHF) in Botswana. Methods: Socio-demographic, clinical and laboratory data were collected from 193 consecutive patients admitted with AHF at Princess Marina Hospital in Gaborone between February 2014 and February 2015. The length of hospital stay and 30-, 90- and 180-day in-hospital mortality rates were assessed. Results: The mean age was 54 ± 17.1 years, and 53.9% of the patients were male. All patients were symptomatic (77.5% in NYHA functional class III or IV) and the majority (64.8%) presented with significant left ventricular dysfunction. The most common concomitant medical conditions were hypertension (54.9%), human immuno-deficiency virus (HIV) (33.9%), anaemia (23.3%) and prior diabetes mellitus (15.5%). Moderate to severe renal dysfunction was detected in 60 (31.1%) patients. Peripartum cardiomyopathy was one of the important causes of heart failure in female patients. The most commonly used treatment included furosemide (86%), beta-blockers (72.1%), angiotensin converting enzyme inhibitors (67.4%), spironolactone (59.9%), digoxin (22.1%), angiotensin receptor blockers (5.8%), nitrates (4.7%) and hydralazine (1.7%). The median length of stay was nine days, and the in-hospital mortality rate was 10.9%. Thirty-, 90- and 180-day case fatality rates were 14.7, 25.8 and 30.8%, respectively. Mortality at 180 days was significantly associated with increasing age, lower haemoglobin level, lower glomerular filtration rate, hyponatraemia, higher N-terminal pro-brain natriuretic peptide levels, and prolonged hospital stay. Conclusions: AHF is a major public health problem in Botswana, with high in-hospital and post-discharge mortality rates and prolonged hospital stays. Late and symptomatic presentation is common, and the most common aetiologies are preventable and/or treatable co-morbidities, including hypertension, diabetes mellitus, renal failure and HIV.
Undiagnosed and diagnosed diabetes mellitus among hospitalised acute heart failure patients in Botswana
(SAGE open medicine, 2017) Mwita, Julius Chacha; Magafu, Mgaywa Gilbert Mjungu Damas; Omech, Bernard; Tsima, Billy; Dewhurst, Matthew J; Goepamang, Monkgogi; Mashalla, Yohana
Objective: The objective of this study was to determine the burden of diagnosed and undiagnosed type 2 diabetes mellitus among patients hospitalised with acute heart failure in Botswana. Methods: The study enrolled 193 consecutive patients admitted with acute heart failure to the medical wards at Princess Marina Hospital in Gaborone. Patients were classified as previously known diabetics, undiagnosed diabetics (glycated haemoglobin ≥ 6.5%) or as non-diabetics (glycated haemoglobin < 6.5%). Data on other comorbid conditions such as hypertension, atrial fibrillation, ischaemic heart disease, stroke, and renal failure were also collected. Results: The mean (SD) age of the participants was 54.2 (17.1) years and 53.9% were men. The percentage of known and undiagnosed diabetes mellitus was 15.5% and 12.4%, respectively. Diabetic patients were significantly more likely to have hypertension (77.8% vs 46.0%, p < 0.001), ischaemic heart disease (20.4% vs 5.0%, p < 0.001), chronic kidney disease (51.3% vs 23.0%, p < 0.001), and stroke (20.4% vs 5.8%, p < 0.01). In addition, diabetics were older than non-diabetics (61.0 years vs 51.6 years, p < 0.001). Conclusion: About 27.9% of patients admitted with acute heart failure in Botswana had diabetes, and almost half of them presented with undiagnosed diabetes. These findings indicate that all hospitalised patients should be screened for diabetes.
Anaemia, renal dysfunction and in-hospital outcomes in patients with heart failure in Botswana
(South African Medical Journal, 2018) Mwita, Julius Chacha; Magafu, Mgaywa Gilbert Mjungu Damas; Omech, Bernard; Dewhurst, Matthew J; Mashalla, Yohana
Background. Anaemia and renal dysfunction are associated with an increased morbidity and mortality in heart failure (HF) patients. Objective. To estimate the frequency and impact of anaemia and renal dysfunction on in-hospital outcomes in patients with HF. Methods. A total of 193 consecutive patients with HF admitted to Princess Marina Hospital, Gaborone, Botswana, from February 2014 to February 2015, were studied. Anaemia was defined as haemoglobin <13 g/dL for men and <12 g/dL for women. Renal dysfunction was defined by an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, calculated by the simplified Modification of Diet in Renal Disease formula. The in-hospital outcomes included length of hospital stay and mortality. Results. The mean (standard deviation (SD)) age was 54.2 (17.1) years and 53.9% of the patients were men. The overall median eGFR was 75.9 mL/min/1.73 m2 and renal dysfunction was detected in 60 (31.1%) patients. Renal dysfunction was associated with hypertension (p=0.01), diabetes mellitus (p=0.01) and a lower haemoglobin level (p=0.008). The mean (SD) haemoglobin was 12.0 (3.0) g/dL and 54.9% of the patients were anaemic. Microcytic, normocytic and macrocytic anaemia were found in 32.1%, 57.5% and 10.4% of patients, respectively. The mean (SD) haemoglobin level for males was significantly higher than for females (12.4 (3.3) g/dL v. 11.5 (2.5) g/dL; p=0.038). Anaemia was more common in patients with diabetes (p=0.028) and in those with increased left ventricular ejection fraction (p=0.005). Neither renal dysfunction nor anaemia was significantly associated with the length of hospital stay or in-hospital mortality. Conclusion. Anaemia and renal dysfunction are prevalent in HF patients, but neither was an independent predictor of length of stay or in-hospital mortality in this population. These findings indicate that HF data in developed countries may not apply to countries in sub- Saharan Africa, and call for more studies to be done in this region.
Coping with post-war mental health problems among survivors of violence in Northern Uganda: Findings from the WAYS study
(J Health Psychol, 2018-05-01) Amone-P'Olak, Kennedy; Omech, Bernard
Cognitive emotion regulation strategies and mental health problems were assessed in a sample of war-affected youth in Northern Uganda. Univariable and multivariable regression models were fitted to assess the influence of CERS on mental health problems. Maladaptive cognitive emotion regulation strategies (e.g., rumination) were significantly associated with more mental health problems while adaptive cognitive emotion regulation strategies (e.g., putting into perspective) were associated with reporting fewer symptoms of mental health problems. The youth with significant scores on mental health problems (scores ≥ 85th percentile) reported more frequent use of maladaptive than adaptive strategies. Interventions to reduce mental health problems should focus on enhancing the use of adaptive strategies.
Knowledge of alcohol-disease links and sociodemographic factors as predictors of support for alcohol-related policies among university students in Botswana
(Drugs: Education, Prevention and Policy, 2019) Amone-P’Olak, Kennedy; Chilunga, Wilfred; Omech, Bernard; Renison Opondo, Phillip
Background: Worldwide, harmful alcohol use is causally related to about 60 diseases and is linked to about 3.3 million deaths annually. Yet, awareness of alcohol-disease links is low. Objective: This study aims to assess socio-demographic characteristics and knowledge of alcoholdisease links as predictors of support for alcohol-related policies. Methods: A survey of 615 university students (age¼19.8; SD¼1.6; 18–25) in Botswana assessed alcohol use and knowledge of alcohol-disease links as predictors of support for alcohol-related policies. T-tests and regression analyses were performed to estimate differences and predictors. Results: Forty per cent of respondents (n¼245) use alcohol, 38% (n¼93) of whom were hazardous users. Awareness of alcohol-disease links was low for diabetes (39%) and cancer (41%) but high for liver cirrhosis (89%) and injuries (87%). Female gender (relative to male) (b¼0.19, 95% CI: 0.11, 0.27), harmful alcohol use (b¼ 0.49, 95% CI: 0.56, 0.42), higher maternal education (b¼0.11, 95% CI: 0.02, 0.18), and more knowledge of alcohol-disease links (b¼0.13, 95% CI: 0.05, 0.21) predicted support for policies. Conclusions: Awareness of alcohol-disease links was low. Support for policies was predicted by being female (relative to male), reporting no harmful alcohol use, having more educated mothers, and knowledge of alcohol-disease links. Improving awareness of alcohol-disease links could be an effective intervention to increase support for alcohol-related policies.
Autoimmune skin disease among dermatology outpatients in Botswana: a retrospective review
(International journal of dermatology, 2019) Madu, Pamela N.; Williams, Victoria L.; Noe, Megan H.; Omech, Bernard; Kovarik, Carrie L.; Wanat, Karolyn A.
Background There is a paucity of data describing autoimmune skin diseases in sub- Saharan Africa and in HIV positive cohorts. We describe the incidence of autoimmune skin diseases in public dermatology clinics in Botswana. Methods New patient records from public dermatology clinics were reviewed retrospectively for the period of September 2008 to December 2015. New diagnoses of cutaneous lupus erythematosus, systemic lupus erythematosus (SLE) with cutaneous involvement, dermatomyositis, systemic sclerosis, lichen sclerosus, bullous pemphigoid, pemphigus foliaceus, pemphigus vulgaris, and pemphigus vegetans were identified. Demographic data were recorded, and incidence was determined. Results A total of 262 patients were diagnosed with autoimmune skin disease (4% of all new patients) with an incidence rate of 28.8 (per 1,000,000). Cutaneous lupus was the most common diagnosis with discoid lupus occurring most frequently (12.6). The incidence of systemic sclerosis (2.2), morphea (1.6), lichen sclerosus (1.5), SLE with cutaneous involvement (1.3) and dermatomyositis (1.2) was relatively lower. Bullous pemphigoid was the most common bullous disease (3.8). Pemphigus foliaceus (0.9), pemphigus vulgaris (0.6), and pemphigus vegetans (0.2) were observed at a lower rate. At least 19.8% of these patients were also HIV positive. Conclusions The incidence of autoimmune skin diseases in Botswana is lower compared to other published studies in other geographic areas, which may be reflective of a younger population, barriers to access, genetic differences, and a lack of comparative studies in sub-Saharan Africa. The hygiene hypothesis and helminth infections may also contribute to these differences. Further studies are needed to understand these disorders in this region
Glycaemic, blood pressure and lowdensity lipoprotein-cholesterol control among patients with diabetes mellitus in a specialised clinic in Botswana: a cross-sectional study
(BMJ Open, 2019) Mwita, Julius Chacha; Francis, Joel M; Omech, Bernard; Botsile, Elizabeth; Oyewo, Aderonke; Mokgwathi, Matshidiso; Molefe-Baikai, Onkabetse Julia; Godman, Brian; Tshikuka, Jose-Gaby
Objective Control of glycaemic, hypertension and lowdensity lipoprotein-cholesterol (LDL-C) among patients with type 2 diabetes mellitus (T2DM) is vital for the prevention of cardiovascular diseases. The current study was an audit of glycaemic, hypertension and LDL-C control among ambulant patients with T2DM in Botswana. Also, the study aimed at assessing factors associated with attaining optimal glycaemic, hypertension and LDL-C therapeutic goals. Design A cross-sectional study. Setting A specialised public diabetes clinic in Gaborone, Botswana. Participants Patients with T2DM who had attended the clinic for ≥3 months between August 2017 and February 2018. Primary outcome measure The proportion of patients with optimal glycaemic (HbA1c<7%), hypertension (blood pressure <140/90 mm Hg) and LDL-C (<1.8 mmol/L) control. Results The proportions of patients meeting optimal targets were 32.3% for glycaemic, 54.2% for hypertension and 20.4% for LDL-C. Age≥ 50 years was positively associated with optimal glycaemic control (adjusted OR [AOR] 5.79; 95% CI 1.08 to 31.14). On the other hand, an increase in diabetes duration was inversely associated with optimal glycemic control (AOR 0.91; 95% CI 0.85 to 0.98). Being on an ACE inhibitor was inversely associated with optimal hypertension control (AOR 0.35; 95% CI 0.14 to 0.85). Being female was inversely associated with optimal LDL-C control (AOR 0.24; 95% CI (0.09 - 0.59). Conclusion Patients with T2DM in Gaborone, Botswana, presented with suboptimal control of recommended glycaemic, hypertension and LDL-C targets. These findings call for urgent individual and health systems interventions to address key determinants of the recommended therapeutic targets among patients with diabetes in this setting.
Stroke and HIV in Botswana: A prospective study of risk factors and outcomes
(Journal of the Neurological Sciences, 2020) Beardena, David R.; Omech, Bernard; Rulaganyangc, Ikanyeng; Sesayd, Sheikh O.; Kolsone, Dennis L.; Kasnere, Scott E.; Mullene, Michael T.
Objective: HIV is associated with an increased risk of stroke, but there are sparse data on risk factors for stroke in people living with HIV in Sub-Saharan African. The goal of this study was to identify HIV-specific stroke characteristics and risk factors among adults in Botswana. Methods: We conducted a prospective cohort study in Gaborone, Botswana from June 2015 to June 2017 comparing risk factors and outcomes among adults with and without HIV admitted for acute stroke. In addition, we conducted a case-control study comparing patients with HIV and stroke to outpatients with HIV and no history of stroke. Results: A total of 52 patients with imaging-confirmed acute stroke were enrolled. Stroke patients with HIV were younger than those without HIV (median age 40 vs 54, p = .005). Hypertension was the most common risk factor identified in both HIV+ and HIV- groups, but was more common in patients without HIV (81% vs. 55%, p = .04). Patients with HIV were significantly more likely to have a small-vessel lacunar syndrome compared to patients without HIV (67% vs. 29%, p = .02). In the case-control analysis, patients with HIV and stroke were more likely to have hypertension than stroke-free controls (53% vs. 16%; OR 7.2, 95% CI 1.5–33.8, p=.01), and were more likely to drink alcohol (53% vs. 21%, OR 3.7, 95% CI 1.1–12.1, p = .03). Conclusions: Individuals with HIV present with strokes at younger ages than individuals without HIV. Among those with HIV, hypertension and alcohol use are significant risk factors for stroke
Predictors of Somatic Symptomatology in War-Affected Youth in Northern Uganda: Findings from the WAYS Study
(Psychological Studies, 2020) Amone-P’Olak, Kennedy; Omech, Bernard
War experiences have been shown to have adverse long-term psychological sequelae. Nevertheless, the roles of different types of war events in predicting which mental health outcomes remain unclear. This study investigated the effects of different types of war events and socio-demographic characteristics on somatic symptoms in war-affected youth in Northern Uganda. A sample of 539 youth (mean age = 22.39; ± 2.03) participated in the study. Using maximum likelihood estimation in structural equation modelling, regression analyses were fitted to relate binary indicators of different types of war events to one latent factor capturing somatic symptoms. The results indicated that sex, marital status, and war types of ‘‘direct personal harm’’, ‘‘deaths’’, and ‘‘sexual abuse’’ independently and uniquely predicted somatic symptoms. Types of war events should be considered when planning interventions. Somatic symptoms may be a window into physical health and psychological sequelae. Implications for mental health service delivery are discussed.
Employee Motivation and Job Performance in Local Governments: A Case Study of Otuke District Local Government
(Lira University, 2021) Odur, Denis Oremo; Nsisi, Christine
The purpose of this study was to examine the effect of employee motivation on job performance in Local Governments focusing on employee of Otuke District Local government as a case study since employees performance was reported to have reduced between the periods of 2017- 2019. Specifically, the study sought to examine the motivation practices in Otuke District Local Government, to assess the level of job performance in Otuke District Local Government, and determine the extent to which motivation affects job performance in Otuke District Local Government. The target population for the study was 137 employees. The study samples comprised of 102 representatives who are employees of Otuke DLG. Data was analyzed using descriptive statistics, correlation analysis and regression analysis. The result for spearman’s rank correlation analysis revealed that all the constructs of motivation were positively correlated with job performance. The findings of the study revealed a positive significant of Job Security on Job performance in Otuke DLG (Coef. 0.413, p < 0.01). Secondly, the results on the effects of Reward system on Job performance in Otuke DLG further revealed a positive significant effect (Coef. 0.558, p < 0.01). Thirdly, the effect of Leadership relation on Job performance in Otuke DLG was found to be negative and insignificant (Coef. -0.106, p > 0.05). Finally, the results of multiple linear regressions yielded an adjusted R Square value of 0.454, which meant that employee motivation contributes about 45.4% to Job performance in Otuke DLG. Based on the above findings, the study recommends that Otuke DLG should put more efforts on Job security by ensuring that staff are recruited following the right channel, through the right qualification and are confirmed timely in their current positions and reward systems must be very transparent with clear scheme in place for staff promotion, the recognition and remuneration. The study also recommends that Otuke DLG should work ways of improving leadership relations in Otuke DLG for a better performance of employees by the district leaders coming up with plans that aim at improving staff welfare and with practices that promote good leadership relations with employees.
Novel Education Modules Addressing the Underrepresentation of Skin of Color in Dermatology Training
(Journal of Cutaneous Medicine and Surgery, 2021) Slaught, Christa; Madu, Pamela; Chang, Aileen Y.; Williams, Victoria L.; Kebaetse, Masego B.; Nkomazana, Oathokwa; Molefe-Baikai, Onkabetse Julia; Bekele, Negussie A.; Omech, Bernard; Kellman, Philip J.; Krasne, Sally; Kovarik, Carrie L.
Background: Representative images of pathology in patients with skin of color are lacking in most medical education resources. This particularly affects training in dermatology, which relies heavily on the use of images to teach pattern recognition. The presentation of skin pathology can vary greatly among different skin tones, and this lack of representation of dark skin phototypes challenges providers’ abilities to provide quality care to patients of color. In Botswana and other countries in sub-Saharan Africa, this challenge is further compounded by limited resources and access to dermatologists. There is a need for improved and accessible educational resources to train medical students and local medical providers in basic skin lesion description and diagnosis. Objectives: We examined whether online Perceptual and Adaptive Learning Modules (PALMs) composed of representative dark skin images could efficiently train University of Botswana medical students to more accurately describe and diagnose common skin conditions in their community. Methods: Year 4 and 5 medical students voluntarily completed PALMs that teach skin morphology, configuration, and distribution terminology and diagnosis of the most common dermatologic conditions in their community. Pre-tests, post-tests and delayed-tests assessed knowledge acquisition and retention. Results: PALMs training produced statistically significant (P < .0001) improvements in accuracy and fluency with large effect sizes (1.5, 3.7) and good retention after a 12.5-21-week median delay. Limitations were a self-selected group of students, a single institution, slow internet connections, and high drop-out rates. Conclusions: Overall, population-specific PALMs are a useful tool for efficient development of pattern recognition in skin disease description and diagnosis.
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 the passive case-finding (PCF) strategy in the Tuberculosis control program in Southwestern Uganda. Methods: The study utilized decision-analytic modeling and bottom-up costing (ingredients) methods. The study obtained cost and probability estimates from National TB program data, activity costs, published literature, and expert opinions. It was performed from the societal and provider perspectives over 1.5 years across 12 facilities in Ntungamo, 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 costs 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-effective 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 PCF. 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.
Factors Associated with IUCD Use Among Women of Reproductive Age Attending Family Planning Clinics at Mbale District.
(Lira University, 2022) Ayeko, Jackson; Kumakech, Edward; Acen, Joy
Background Intrauterine Contraceptive Device (IUCD) is among the most effective contraceptive methods in the market with increasing use globally. The use is predominant in few parts of the world, with Sub-Saharan Africa relying on other methods. In Uganda, IUCD utilization remains very low at 1.5% compared to other methods despite several interventions by the government. The objective of this study was to determine the factors associated with IUCD use among women of reproductive age attending family planning clinics in selected public health facilities within Mbale district. Methodology A facility based cross-sectional study was used among randomly selected women who came to obtain different contraceptive methods in the selected public health facilities. Information was obtained face-to-face by trained research assistants using a pre-coded structured questionnaire. Factors associated with IUCD use were identified by multi-variable binary logistic regression models using the backward stepwise method. Results. After running multivariable binary logistic regression, IUCD use was associated with Women who were employed (adjusted OR= 14.00, 95% CI; 2.80-70.07), those who wanted to wait for 6 -10 years before having the next pregnancy (Adjusted OR= 12.19, 95% CI; 1.35-110.08), and those who thought IUCD was associated with cancer (Adjusted OR= 0.15, 95% CI; 0.03-0.68). Conclusion In conclusion, the study re-enforced the need to reach out with contraceptive methods especially IUCD to women who have a busy schedule and also points out the need for proper counselling to ensure that women who plan to stay for long should be counselled to also consider IUCD use which has a longer duration of action. Further, Proper health education is needed through different channels to address the issues of myths and misconceptions which hinders utilization of IUCD.
Results-Based Financing, Motivation, And Satisfaction of Health Workers at Lower Level Primary Health Care Facilities in Lira District
(Lira University, 2022) Orec, Isaac; Akello, Judith Abal
Background: Globally, Results-Based Financing consists of monetary or non-monetary transfers made to national or subnational governments, managers, providers, or consumers of health services contingent on verified attainment of predefined results within the context of Maternal Child and Newborn Health. In Uganda, monitoring of Results-Based Financing activities at lower level public health facilities in Lira district, involves the use of quality assessment tool to verify performance against predefined health indicators on a quarterly basis. Both quality and quantitiy scores are to determine payment of the health workers. However, no attempt is made towards the assessment of health workers’ motivation and their job satisfaction in realation to results-based financing programs. Overall Objective: To assess the contributions of Results-Based Financing strategy on health workers’ motivation and job satisfaction in Lira District Method: The study design was a descriptive cross-sectional using mixed-method approaches Systematic random sampling technique using lottery method was used to sample the professional health workers where the Kth interval was obtained by dividing the N by the sample size. Purposive sampling technique was used to sample the health administrators as key informants of the study. Data analysis: Data were analyzed using STATA version 17. Every questionnaire was checked for completeness at the end of each interview. Data were scanned for out-of-range and missing values before commencing data analysis. Linear regression analysis was run and then data analyzed as; Univariate analysis to analyze categorical variables and was presented in percentages and frequencies. Bivariate analysis to model the relationship between the independent variables and the dependent variable was also carried out using limear regression. The results were expressed at 95% confidence interval and statistical significance set at a P-value of 0.05. Results: Results of the study indicated that 50.4% of health workers were satisfied with their current job and close to half (49.6%) were dissatisfied. The overall motivation score of health workers in this study was 59.9%. The results show that the predictors of job satisfaction were providing autonomy in decision making at facility level (aOR 4.68, 95% CI: 2.21-7.15; p<0.001) and rapid changes at facility (aOR 2.93, 95% CI: 1.37-4.47; p<0.001) . Further still, the findings indicated that the predictors of motivation were age of the participant (aOR 2.53, 95% CI: 1.26-3.80; p<0.001) and enchaning support supervison (aOR 2.67, 95% CI: 1.42-3.94; p<0.001). Conclusion: The overall level of health professionals’ job satisfaction was 50.4%, suggesting that many health professionals close to half of health workers at lower level primary health care facilities are not satisfied with their current job. The findings from this study provided suggestive evidence that the two autonomy in decision making at facility level and rapid changes at facility became important predictors of health workers’ job satisfaction at the backdrop of lira district’s current health system reform. Age of the respondents was found to be a strong predictor of motivation among health workers additionally, enchaning support supervison was a predictor of motivation among health workers. This suggests that supportive supervision increases health worker motivation, including performance and quality of care. The study recommends that the management of the health care facilities should determine the provide incentives that the health workers are interested in. This would motivate the healthcare workers since they are provided with what they need.
Health System Responsiveness for Persons with HIV and Disability in South Western Uganda
(Dovepress, 2023) Kibet, Emmanuel; Namirimu, Florence; Nakazibwe, Felista; Kyagera, Arnold Zironda; Ayebazibwe, Disan; Omech, Bernard
Background: Inequitable access to Human Immunodeficiency Virus/Acquired Immune Syndrome (HIV/AIDS) Treatment and Care Services (HATCS) for People With Disabilities (PWD) is a hurdle to ending the pandemic by 2030. The aim of this study was to evaluate the Health System’s Responsiveness (HSR) and associated factors for PWD attending HATCS at health facilities in South Western Uganda. Methods: Between February and April 2022, we enrolled a total of 106 people with disabilities for a quantitative study and 14 key informants from selected primary care HIV clinics. The World Health Organization Multi-country study’s disability assessment schedules 2.0 and Health system responsiveness (HSR) questionnaire were adopted to measure the level of disabilities and respon- siveness, respectively. The level of HSR was evaluated using descriptive analysis. The association between socio-demographics, level of disabilities and HSR was evaluated through binary and multivariable logistic regression. The qualitative data were collected from 14 key informants using interview guide and analyzed according to thematic areas (deductive approaches). Results: Overall, Health system responsiveness (HSR) was at 47.62% being acceptable to people living with HIV and Disabilities in south western Uganda. Across different domains, the best performance was reported in social consideration (68.57%) and autonomy (67.62%). The least performance was registered in dignity (2.83%), confidentiality (2.91%), prompt Attention (17.35%) and Choices (30.48%). Whereas performance in communications (53.92%) and quality of basic amenities (42.27%) were average. There were no socio-demographics or disability variables that were predictive of HATCS responsiveness. PWDs experienced lack of social support, poor communication, stigma and discrimination during the HATCs services. On the other hand, the health-care providers felt frustrated by their inability to communicate effectively with PWDs and meet their need for social support. Conclusion: HSR was comparatively low, with dignity, confidentiality, prompt attention, and choice ranking worst. To address the universal and legitimate requirements of PWDs in accessing care, urgent initiatives are required to create awareness among all stakeholders. Keywords: HIV/AIDS, disability, health system responsiveness, Uganda

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