Project description:BackgroundThe World Health Organization recommends use of multiple approaches to control malaria. The integrated approach to malaria prevention advocates the use of several malaria prevention methods in a holistic manner. This study assessed perceptions and practices on integrated malaria prevention in Wakiso district, Uganda.MethodsA clustered cross-sectional survey was conducted among 727 households from 29 villages using both quantitative and qualitative methods. Assessment was done on awareness of various malaria prevention methods, potential for use of the methods in a holistic manner, and reasons for dislike of certain methods. Households were classified as using integrated malaria prevention if they used at least two methods. Logistic regression was used to test for factors associated with the use of integrated malaria prevention while adjusting for clustering within villages.ResultsParticipants knew of the various malaria prevention methods in the integrated approach including use of insecticide treated nets (97.5%), removing mosquito breeding sites (89.1%), clearing overgrown vegetation near houses (97.9%), and closing windows and doors early in the evenings (96.4%). If trained, most participants (68.6%) would use all the suggested malaria prevention methods of the integrated approach. Among those who would not use all methods, the main reasons given were there being too many (70.2%) and cost (32.0%). Only 33.0% households were using the integrated approach to prevent malaria. Use of integrated malaria prevention by households was associated with reading newspapers (AOR 0.34; 95% CI 0.22 -0.53) and ownership of a motorcycle/car (AOR 1.75; 95% CI 1.03 - 2.98).ConclusionAlthough knowledge of malaria prevention methods was high and perceptions on the integrated approach promising, practices on integrated malaria prevention was relatively low. The use of the integrated approach can be improved by promoting use of multiple malaria prevention methods through various communication channels such as mass media.

Project description:BackgroundBesides use of insecticide-treated mosquito nets (ITNs) and indoor residual spraying (IRS), other complimentary measures including suitable housing structures, and environmental management that reduce breeding of malaria vectors, can be implemented at households to prevent the disease. However, most studies on malaria prevention have focused mainly on ITNs and IRS. The aim of this study was therefore to assess malaria prevention practices beyond ITNs and IRS, and associated environmental risk factors including housing structure in rural Wakiso district, Uganda.MethodsA clustered cross-sectional survey was conducted among 727 households in Wakiso district. Data were collected using an interviewer-administered questionnaire and observational checklist. The questionnaire assessed participants' household practices on malaria prevention, whereas the checklist recorded environmental risk factors for malaria transmission, and structural condition of houses. Poisson regression modeling was used to identify factors associated with use of mosquito nets by households.ResultsOf the 727 households, 471 (64.8%) owned at least one mosquito net. Use of mosquito nets by households was higher with increasing education level of participants-primary (aPR = 1.27 [95% CI: 1.00-1.60]), secondary (ordinary level) (aPR = 1.47 [95% CI: 1.16-1.85]) and advanced level / tertiary (aPR = 1.55 [95% CI: 1.19-2.01]), and higher household income (aPR = 1.09 [95% CI: 1.00-1.20]). Additionally, participants who were not employed were less likely to have mosquito nets used in their households (aPR = 0.83 [95% CI: 0.70-0.98]). Houses that had undergone IRS in the previous 12 months were 42 (5.8%), while 220 (43.2%) households closed their windows before 6.00 pm. Environmental risk factors found at households included presence of vessels that could potentially hold water for mosquito breeding 414 (56.9%), and stagnant water in compounds 144 (19.8%). Several structural deficiencies on houses that could promote entry of mosquitoes were found such as lack of screening in ventilators 645 (94.7%), and external doors not fitting perfectly into walls hence potential for mosquito entry 305 (42.0%).ConclusionThere is need to increase coverage and utilisation of ITNs and IRS for malaria prevention in Wakiso district, Uganda. In addition, other malaria prevention strategies such as environmental management, and improving structural condition of houses are required to strengthen existing malaria prevention approaches.

Project description:BackgroundThe control of Plasmodium knowlesi malaria remains challenging due to the presence of macaque monkeys and predominantly outdoor-biting Anopheles mosquitoes around human settlements. This study aims to explore the barriers and facilitators related to prevention of mosquito bites among rural communities living in Sabah, Malaysia using the participatory visual method, photovoice.MethodsFrom January through June 2022, 26 participants were recruited from four villages in Kudat, Sabah, using purposive sampling. Participants were male and female villagers, aged > 18 years old. After photovoice training in the villages, participants documented facilitators of and barriers related to avoiding mosquito bites using their own smartphone cameras, and provided narratives for their photos. Twelve Focus Group Discussions (FGDs) sessions in three rounds were held to share and discuss the photos, and to address challenges to the avoidance of mosquito bites. All discussions were conducted in the Sabah Malay dialect, and were video and audio recorded, transcribed, and analyzed using reflexive thematic analysis. The Ideation Model, a meta-theoretical model of behaviour change, underpinned this study.ResultsThe most common types of barriers identified by participants included (I) intrapersonal factors such as low perceived threat of malaria, (II) livelihood and lifestyle activities consisting of the local economy and socio-cultural activities, and (III) physical and social environment. The facilitators were categorized into (I) intrapersonal reasons, including having the opportunity to stay indoors, especially women who are housewives, (II) social support by the households, neaighbours and healthcare workers, and (III) support from healthcare services and malaria awareness program. Participants emphasized the importance of stakeholder's support in implementing feasible and affordable approaches to P. knowlesi malaria control.ConclusionResults provided insights regarding the challenges to preventing P. knowlesi malaria in rural Kudat, Sabah. The participation of communities in research was valuable in expanding knowledge of local challenges and highlighting possible ways to overcome barriers. These findings may be used to improve strategies for zoonotic malaria control, which is critical for advancing social change and minimizing health disparities in malaria prevention.

Project description:BackgroundIntegrated community case management (iCCM) strategies aim to reach poor communities by providing timely access to treatment for malaria, pneumonia and diarrhoea for children under 5 years of age. Community health workers, known as Village Health Teams (VHTs) in Uganda, have been shown to be effective in hard-to-reach, underserved areas, but there is little evidence to support iCCM as an appropriate strategy in non-rural contexts. This study aimed to inform future iCCM implementation by exploring caregiver and VHT member perceptions of the value and effectiveness of iCCM in peri-urban settings in Uganda.MethodsA qualitative evaluation was conducted in seven villages in Wakiso district, a rapidly urbanising area in central Uganda. Villages were purposively selected, spanning a range of peri-urban settlements experiencing rapid population change. In each village, rapid appraisal activities were undertaken separately with purposively selected caregivers (n = 85) and all iCCM-trained VHT members (n = 14), providing platforms for group discussions. Fifteen key informant interviews were also conducted with community leaders and VHT members. Thematic analysis was based on the 'Health Access Livelihoods Framework'.ResultsiCCM was perceived to facilitate timely treatment access and improve child health in peri-urban settings, often supplanting private clinics and traditional healers as first point of care. Relative to other health service providers, caregivers valued VHTs' free, proximal services, caring attitudes, perceived treatment quality, perceived competency and protocol use, and follow-up and referral services. VHT effectiveness was perceived to be restricted by inadequate diagnostics, limited newborn care, drug stockouts and VHT member absence - factors which drove utilisation of alternative providers. Low community engagement in VHT selection, lack of referral transport and poor availability of referral services also diminished perceived effectiveness. The iCCM strategy was widely perceived to result in economic savings and other livelihood benefits.ConclusionsIn peri-urban areas, iCCM was perceived as an effective, well-utilised strategy, reflecting both VHT attributes and gaps in existing health services. Depending on health system resources and organisation, iCCM may be a useful transitional service delivery approach. Implementation in peri-urban areas should consider tailored community engagement strategies, adapted selection criteria, and assessment of population density to ensure sufficient coverage.

Project description:BackgroundCommunity health workers (CHWs) are an important cadre of the global health workforce as they are involved in providing health services at the community level. However, evidence on the role of CHWs in delivering interventions for non-communicable diseases (NCDs) in Uganda is limited. This study, therefore, assessed the involvement of CHWs in the prevention and control of NCDs in Wakiso District, Uganda with a focus on their knowledge, attitudes and practices, as well as community perceptions.MethodsA cross-sectional study using mixed methods was conducted which involved a structured questionnaire among 485 CHWs, and 6 focus group discussions (FGDs) among community members. The study assessed knowledge, perceptions including the importance of the various risk factors, and the current involvement of CHWs in NCDs, including the challenges they faced. Quantitative data were analysed in STATA version 13.0 while thematic analysis was used for the qualitative data.ResultsThe majority of CHWs (75.3%) correctly defined what NCDs are. Among CHWs who knew examples of NCDs (87.4%), the majority mentioned high blood pressure (77.1%), diabetes (73.4%) and cancer (63.0%). Many CHWs said that healthy diet (86.2%), physical activity (77.7%), avoiding smoking/tobacco use (70.9%), and limiting alcohol consumption (63.7%) were very important to prevent NCDs. Although more than half of the CHWs (63.1%) reported being involved in NCDs activities, only 20.9 and 20.6% had participated in community mobilisation and referral of patients respectively. The majority of CHWs (80.1%) who were involved in NCDs prevention and control reported challenges including inadequate knowledge (58.4%), lack of training (37.6%), and negative community perception towards NCDs (35.1%). From the FGDs, community members were concerned that CHWs did not have enough training on NCDs hence lacked enough information. Therefore, the community did not have much confidence in them regarding NCDs, hence rarely consulted them concerning these diseases.ConclusionsDespite CHWs having some knowledge on NCDs and their risk factors, their involvement in the prevention and control of the diseases was low. Through enhanced training and community engagement, CHWs can contribute to the prevention and control of NCDs, including health education and community mobilisation.

Project description:BackgroundAntibiotics are increasingly becoming ineffective as antimicrobial resistance (AMR) continues to develop and spread globally-leading to more difficult to treat infections. Countries such as Uganda are still challenged with implementation of AMR related strategies due to data paucity. This includes a lack of data on the prevailing knowledge and awareness of antimicrobial resistance and antibiotic use among farming communities, both commercial and subsistence, which are instrumental in the implementation of targeted interventions. The aim of our study was to assess the knowledge, attitudes and practices on AMR among subsistence and commercial farmers in Wakiso district, central Uganda.MethodsA cross-sectional study was conducted using a semi-structured questionnaire in Wakiso district, Central Uganda in between June and September 2021. Polytomous latent class analyses were performed to group participants based on their responses. Multivariable regression and conditional inference trees were used to determine the association between demographic factors and knowledge on antibiotics and AMR.ResultsA total of 652 respondents participated in the study among whom 84% were able to correctly describe what antibiotics are. Subsistence farmers (OR = 6.89, 95% CI [3.20; 14.83]), and to a lesser extent, farming community members which obtained their main income by another business (OR = 2.25, 95% CI [1.345; 3.75]) were more likely to be able to describe antibiotics correctly than individuals involved in commercial farming. Based on the latent class analysis, three latent classes indicating different levels of knowledge on AMR, were found. Subsistence farming, higher educational level and younger age were found to be associated with belonging to a class of better knowledge.ConclusionThe majority of participants were able to correctly describe antibiotics and aware of AMR, however there was some degree of misunderstanding of several AMR concepts. Targeted AMR interventions should improve awareness and also ensure that not only subsistence farmers, but commercial farmers, are included.

Project description:BackgroundScreening and vaccination against Hepatitis B virus (HBV) infection remains the most effective intervention in curbing the disease. However, there is limited evidence on the factors associated with the uptake of these services in Uganda. This study determined the uptake of HBV screening and vaccination status, and associated factors among Healthcare Providers (HCPs) in Wakiso district, Uganda.Materials and methodsThis cross-sectional study was conducted among 306 HCPs, randomly selected from 55 healthcare facilities. Prevalence ratios (PR) were used to determine the factors associated with HBV screening and vaccination status of HCPs.ResultsOf the 306 HCPs, 230 (75.2%) had ever screened for HBV infection while 177 (57.8%) were fully vaccinated. Being male was positively associated with 'ever been screened' for HBV infection (Adjusted PR = 1.27, 95%CI 1.13-1.41). Working in a public healthcare facility (Adjusted PR = 0.78, 95%CI 0.68-0.90) was negatively associated with ever been screened. Male sex (Adjusted PR = 1.21, 95%CI 1.01-1.46), the belief that the HBV vaccine was safe (Adjusted PR = 1.72, 95%CI 1.03-2.89) and ever been screened (Adjusted PR = 2.28, 95%CI 1.56-3.34) were positively associated with being fully vaccinated. However, working in a public healthcare facility (Adjusted PR = 0.79, 95%CI 0.64-0.98), self-perceived risk of HBV infection (Adjusted PR = 0.72, 95% CI:0.62-0.84), and working in a healthcare facility with infection control guidelines (Adjusted PR = 0.79, 95%CI 0.66-0.95) were negatively associated with being fully vaccinated.ConclusionThree quarters of HCPs had ever been screened for HBV while slightly more than half were fully vaccinated. HBV screening and vaccination interventions need to consider the HCP sex, risk perception, attitude towards safety and efficacy of the hepatitis B vaccine, and healthcare facility characteristics such as ownership and availability of infection control guidelines, in order to be successful.

Project description:BACKGROUND:Hearing loss is a prevalent but neglected disease, especially in low- or middle-income countries. The role of Community Health Workers (CHWs) to deliver primary ear and hearing care has been explored in several studies from a technical standpoint, but understanding perceptions, barriers, and enablers of such an approach from the perspective of CHWs themselves through a health equity lens has been less well documented. METHODS:This qualitative study used photovoice to explore the views and experiences of CHWs in the Seeta Nazigo Parish of Mukono District in the delivery of ear and hearing care in the community. CHWs were trained in ear and hearing care, and provided with digital cameras to capture photographs related to their work in the community over the following 3 months. Individual interviews regarding the photographs were held at the end of each month, in addition to one focus group discussion. A community workshop was convened at the end of the study to display the photos. Thematic analysis of photographs was conducted using Braune and Clarkes six-step framework. We also used the data to explore potential roles for key stakeholders in primary ear and hearing care, and how photovoice may facilitate their engagement. RESULTS:13 CHWs participated in the study. Several themes were generated from analysis. CHWs perceived a high burden of ear and hearing disorders in their community and recognised the role they could play in tackling that burden. Potential barriers identified included a lack of equipment, training, and supervision of CHWs; logistical, financial, or psychological barriers to community participation; and the widespread use of traditional medicine. CHWs identified roles for the government and NGO bodies to enable and support delivery of ear and hearing care in the community. The community workshop was a useful method to engage key stakeholders in this topic. CONCLUSIONS:Photovoice is a powerful method to capture issues affecting CHWs. Here it was used to identify a number of perceptions, barriers and enablers to the delivery of ear and hearing care. Our results may inform future strategy in the field of ear and hearing care, and the potential use of photovoice to enact sociocultural change.

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Facilitators and barriers to integrated malaria prevention in Wakiso district, Uganda: A photovoice study

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