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User fees, health staff incentives, and service utilization in Kabarole District, Uganda
Kipp,Walter; Kamugisha,Jimmy; Jacobs,Phil; Burnham,Gilbert; Rubaale,Tom;
Bulletin of the World Health Organization , 2001, DOI: 10.1590/S0042-96862001001100006
Abstract: objective: to determine the impact of user fees on the utilization of health services in a community-based cost-sharing scheme in kabarole district, western uganda. methods: of the 38 government health units that had introduced user-fee financing schemes, 11 were included in the study. outpatient utilization was assessed as the median number of visits per month before and after cost sharing began. findings: after the introduction of cost sharing, overall utilization of general outpatient services, assessed by combining the data from all the participating units, dropped by 21.3%. utilization increased, however, in facilities located in remote areas, while it decreased in those located in urban or semi-urban areas. the increased utilization in remote facilities was considered to be largely attributable to health workers' incentive payments derived from cost-sharing revenues. conclusions: incentive payments led the health workers to offer improved services. other factors may also have been influential, such as an improved drug supply to health facilities and increased public identification with community projects in remote areas.
User fees, health staff incentives, and service utilization in Kabarole District, Uganda  [cached]
Kipp Walter,Kamugisha Jimmy,Jacobs Phil,Burnham Gilbert
Bulletin of the World Health Organization , 2001,
Abstract: OBJECTIVE: To determine the impact of user fees on the utilization of health services in a community-based cost-sharing scheme in Kabarole District, western Uganda. METHODS: Of the 38 government health units that had introduced user-fee financing schemes, 11 were included in the study. Outpatient utilization was assessed as the median number of visits per month before and after cost sharing began. FINDINGS: After the introduction of cost sharing, overall utilization of general outpatient services, assessed by combining the data from all the participating units, dropped by 21.3%. Utilization increased, however, in facilities located in remote areas, while it decreased in those located in urban or semi-urban areas. The increased utilization in remote facilities was considered to be largely attributable to health workers' incentive payments derived from cost-sharing revenues. CONCLUSIONS: Incentive payments led the health workers to offer improved services. Other factors may also have been influential, such as an improved drug supply to health facilities and increased public identification with community projects in remote areas.
Factors associated with malnutrition among children in internally displaced person\'s camps, northern Uganda
MA Olwedo, E Mworozi, H Bachou, CG Orach
African Health Sciences , 2008,
Abstract: Introduction Since mid 1990s, Uganda has had an estimated 1.6 million internally displaced persons (IDPs) in the northern and eastern districts. A major cause of morbidity and mortality amongst children in displaced settings is protein energy malnutrition. Objective To estimate the prevalence of and describe the risk factors for protein energy malnutrition among under five years old children living in internally displaced persons camps in Omoro county Gulu district. Methods This was a cross sectional study undertaken among internally displaced people\'s in Omoro county, Gulu district during 13 - 23rd September 2006. Anthropometric measurements of 672 children aged 3 – 59 months were undertaken and all their caretakers interviewed. The anthropometric measurements were analyzed using z- scores of height-for-age (H/A) and weight-for-height (W/ H) indices. Qualitative data were collected through 6 focus group discussions, key informant interviews and observation. Data were captured using Epi Data version 3.0 and analyzed using EPI-INFO version 3.3.2 and SPSS version 12.0 computer packages respectively. Results The prevalence of global stunting was found to be 52.4% and of global acute malnutrition 6.0%. Male children are at risk of being stunted Adjusted OR 1.57 95% CI 1.15-2.13; p value=0.004. Children in the age group 3 – 24 months were at risk of acute malnutrition Adjusted OR 2.78 95% CI 1.26-6.15; p value=0.012 while de-worming was protective Adjusted OR 0.44 95% CI 0.22-0.88; p value=0.018. The main sources of foodstuff for IDPs include food rations distributed by WFP, cultivation and purchase. Conclusion and Recommendations There is high prevalence of protein energy malnutrition (stunting) among children in the internally displaced people\'s camps in Gulu district. Male children are at an increased risk of stunting while children aged between 3 – 24 months are at an increased risk of suffering from acute malnutrition. Stakeholders including local government and relief organizations should intensify efforts to improve the nutritional status of IDPs especially children in the camp settings. The quantity of and access to household food supplies, health education on infant and child feeding and integrated management of childhood illnesses (IMCI) activities in the camps should be strengthened. African Health Sciences Vol. 8 (4) 2008: pp. 244-252
Risk factors for childhood malnutrition in Roma settlements in Serbia
Teresa Janevic, Oliver Petrovic, Ivana Bjelic, Amber Kubera
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-509
Abstract: Anthropometric and sociodemographic measures were obtained for 1192 Roma children under five living in Roma settlements from the 2005 Serbia Multiple Indicator Cluster Survey. Multiple logistic regression was used to relate family and child characteristics to the odds of stunting, wasting, and underweight.The prevalence of stunting, wasting, and underweight was 20.1%, 4.3%, and 8.0%, respectively. Nearly all of the children studied fell into the lowest quintile of wealth for the overall population of Serbia. Children in the lowest quintile of wealth were four times more likely to be stunted compared to those in the highest quintile, followed by those in the second lowest quintile (AOR = 2.1) and lastly by those in the middle quintile (AOR = 1.6). Children who were ever left in the care of an older child were almost twice as likely to stunted as those were not. Children living in urban settlements showed a clear disadvantage with close to three times the likelihood of being wasted compared to those living in rural areas. There was a suggestion that maternal, but not paternal, education was associated with stunting, and maternal literacy was significantly associated with wasting. Whether children were ever breastfed, immunized or had diarrhoeal episodes in the past two weeks did not show strong correlations to children malnutrition status in this Roma population.There exists a gradient relationship between household wealth and stunting even within impoverished settlements, indicating that among poor and marginalized populations socioeconomic inequities in child health should be addressed. Other areas on which to focus future research and public health intervention include maternal literacy, child endangerment practices, and urban settlements.Malnutrition is an important indicator of child health. A significant contributing factor to infant and child mortality, poor nutritional status during childhood also has implications for adult economic achievement and health. [1]
Nutrition education to improve dietary intake and micronutrient nutriture among children in less-resourced areas: a randomised controlled intervention in Kabarole district, western Uganda
M Kabahenda, RM Mullis, JG Erhardt, C Northrop-Clewes, SY Nickols
South African Journal of Clinical Nutrition , 2011,
Abstract: Objective: To determine whether nutrition education targeting the child-feeding practices of low-income rural caregivers will reduce anaemia and improve vitamin A nutriture of the young children in their care. Design: A controlled intervention trial, based on experiential learning theory. Forty-six women completed a nine-session nutrition education programme, while controls (n = 43) concurrently engaged in sewing classes. Setting: Two rural farming communities in the Kabarole district, western Uganda. Subjects: Less literate, low-income rural female caregivers and the children in their care (6-48 months). Outcome measures: Caregivers’ child-feeding practices and the children’s nutritional status were assessed at baseline, one month after intervention (Follow-up 1) and one year from baseline (Follow-up 2). Results: Caregivers in the intervention group reported improved child snacking patterns, food-selection practices, meal adequacy, and food variety. Children in the intervention group recorded lower haemoglobin levels at baseline (9.86 vs. 10.70 g/dl) and caught up with controls at Follow-up 1 (10.06 vs. 10.78 g/dl). However, changes were not sustained. Mean retinol-binding protein improved from 0.68 ìmol/l (95% CI: 0.57-0.78) to 0.91 ìmol/l (95% CI: 0.78-1.03) among intervention children, but remained approximately the same in controls. Vitamin A nutriture was influenced by infections. Conclusion: Nutrition education significantly improved feeding practices and children’s nutritional status. The effectiveness and sustainability of this programme can be enhanced if nutrition education is integrated into other food-production and public health programmes
Agreement between diagnoses of childhood lymphoma assigned in Uganda and by an international reference laboratory  [cached]
Orem J,Sandin S,Weibull CE,Odida M
Clinical Epidemiology , 2012,
Abstract: Jackson Orem,1–3 Sven Sandin,1 Caroline E Weibull,1 Michael Odida,4 Henry Wabinga,4 Edward Mbidde,2,3 Fred Wabwire-Mangen,5 Chris JLM Meijer,6 Jaap M Middeldorp,6 Elisabete Weiderpass1,7,81Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; 2Uganda Cancer Institute, 3School of Medicine, 4School of Biomedical Sciences, 5School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; 6Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; 7Cancer Registry of Norway, Oslo; Department of Community Medicine, University of Troms , Troms , Norway; 8Samfundet Folkh lsan, Helsinki, FinlandBackground: Correct diagnosis is key to appropriate treatment of cancer in children. However, diagnostic challenges are common in low-income and middle-income countries. The objective of the present study was to assess the agreement between a clinical diagnosis of childhood non-Hodgkin lymphoma (NHL) assigned in Uganda, a pathological diagnosis assigned in Uganda, and a pathological diagnosis assigned in The Netherlands.Methods: The study included children with suspected NHL referred to the Mulago National Referral Hospital, Kampala, Uganda, between 2004 and 2008. A clinical diagnosis was assigned at the Mulago National Referral Hospital, where tissue samples were also obtained. Hematoxylin and eosin-stained slides were used for histological diagnosis in Uganda, and were re-examined in a pathology laboratory in The Netherlands, where additional pathological, virological and serological testing was also carried out. Agreement between diagnostic sites was compared using kappa statistics.Results: Clinical and pathological diagnoses from Uganda and pathological diagnosis from The Netherlands was available for 118 children. The agreement between clinical and pathological diagnoses of NHL assigned in Uganda was 91% (95% confidence interval [CI] 84–95; kappa 0.84; P < 0.001) and in The Netherlands was 49% (95% CI 40–59; kappa 0.04; P = 0.612). When Burkitt's lymphoma was considered separately from other NHL, the agreement between clinical diagnoses in Uganda and pathological diagnoses in Uganda was 69% (95% CI 59–77; kappa 0.56; P < 0.0001), and the corresponding agreement between pathological diagnoses assigned in The Netherlands was 32% (95% CI 24–41; kappa 0.05; P = 0.326). The agreement between all pathological diagnoses assigned in Uganda and The Netherlands was 36% (95% CI 28–46; kappa 0.11; P = 0.046).Conclusion: Clinical diagnosis of NHL in Uganda has a high probability of error c
Prevention and treatment of childhood malnutrition in rural Malawi: Lungwena nutrition studies
C Thakwalakwa, J Phuka, V Flax, K Maleta, P Ashorn
Malawi Medical Journal , 2009,
Abstract: Malawi is one of the poorest countries in the world with poor health and nutritional indicators. It is sometimes only surpassed by countries under conflict. Such a situation necessitated a search for local causes of undernutrition which heavily contribute to childhood mortality in Malawi. Literature showed that certain aspects of undernutrition had not been wholly explained. The determination of when growth faltering starts had been hampered by lack of an appropriate reference standard. This raised a question when growth faltering actually start, as preventive strategies had to be instituted early in the development of the problem. For this, local studies were needed. The review highlighted the fact that determinants of malnutrition may not have the same importance in all settings and thus preventive strategies that work in one place may not work in all settings. This meant that determination of local causes and effective interventions was one way of alleviating the problem. It had been standard to consider underweight and stunting as being resultant from the same causal factors. The epidemiology of wasting and stunting and the relationship of weight and height gain suggested possible difference in aetiology and a need to develop a clear understanding of their relationship, which in turn could help in developing effective interventions.
Gut Microbiota in Children Hospitalized with Oedematous and Non-Oedematous Severe Acute Malnutrition in Uganda  [PDF]
Kia Hee Schultz Kristensen?,Maria Wiese?,Maren Johanne Heilskov Rytter?,Mustafa ?z?am?,Lars Hestbjerg Hansen?,Hanifa Namusoke?,Henrik Friis?,Dennis Sandris Nielsen
PLOS Neglected Tropical Diseases , 2016, DOI: 10.1371/journal.pntd.0004369
Abstract: Background Severe acute malnutrition (SAM) among children remains a major health problem in many developing countries. SAM manifests in both an oedematous and a non-oedematous form, with oedematous malnutrition in its most severe form also known as kwashiorkor. The pathogenesis of both types of malnutrition in children remains largely unknown, but gut microbiota (GM) dysbiosis has recently been linked to oedematous malnutrition. In the present study we aimed to assess whether GM composition differed between Ugandan children suffering from either oedematous or non-oedematous malnutrition. Methodology/Principal Findings As part of an observational study among children hospitalized with SAM aged 6–24 months in Uganda, fecal samples were collected at admission. Total genomic DNA was extracted from fecal samples, and PCR amplification was performed followed by Denaturing Gradient Gel Electrophoresis (DGGE) and tag-encoded 16S rRNA gene-targeted high throughput amplicon sequencing. Alpha and beta diversity measures were determined along with ANOVA mean relative abundance and G-test of independence followed by comparisons between groups. Of the 87 SAM children included, 62% suffered from oedematous malnutrition, 66% were boys and the mean age was 16.1 months. GM composition was found to differ between the two groups of children as determined by DGGE (p = 0.0317) and by high-throughput sequencing, with non-oedematous children having lower GM alpha diversity (p = 0.036). However, beta diversity analysis did not reveal larger differences between the GM of children with oedematous and non-oedematous SAM (ANOSIM analysis, weighted UniFrac, R = -0.0085, p = 0.584; unweighted UniFrac, R = 0.0719, p = 0.011). Conclusions/Significance Our results indicate that non-oedematous SAM children have lower GM diversity compared to oedematous SAM children, however no clear compositional differences were identified.
Understanding socio-economic determinants of childhood mortality: a retrospective analysis in Uganda
Fred Nuwaha, Juliet Babirye, Olico Okui, Natal Ayiga
BMC Research Notes , 2011, DOI: 10.1186/1756-0500-4-484
Abstract: We compared the childhood mortalities and their average annual reduction rate (AARR) of Teso sub-region with those of Uganda for the period 1959 to 1969. We also compared indicators of social economic well being (such as livestock per capita and per capita intake of protein/energy). In addition data was compared on other important determinants of child survival such as level of education and rate of urbanisation.In 1969 the infant mortality rate (IMR) for Teso was 94 per 1000 live births compared to the 120 for Uganda. Between 1959 and 1969 the AARR for IMR for Teso was 4.57% compared to 3% for Uganda. It was interesting that the AARR for Teso was higher than that that of 4.4.% required to achieve millennium development goal number four (MDG4). The rate of urbanisation and the level of education were higher in Uganda compared to Teso during the same period. Teso had a per capita ownership of cattle of 1.12 compared to Uganda's 0.44. Teso sub region had about 3 times the amount of protein and about 2 times the amount of calories compared to Uganda.We surmise that higher ownership of cattle and growing of high protein and energy foods might have been responsible for better childhood survival in Teso compared to Uganda.The socio-economic condition of the population is a major determinant of childhood survival at individual, household and community level [1,2]. Social economic conditions influence the risk of childhood mortality by influencing intermediate or proximate variables such maternal factors, environmental contamination, nutrient deficiency, injury and personal illness control [3-8]. Childhood mortality is thus multi-factorial in causality, may have long latency periods between exposure and manifestation and thus the need for a multidisciplinary approach to understanding the causes and methods of alleviating childhood mortality is clear [9,10]. Such an approach is also useful to understand the mortality disparities say between geographical regions and between d
Using extended concentration and achievement indices to study socioeconomic inequality in chronic childhood malnutrition: the case of Nigeria
Olalekan A Uthman
International Journal for Equity in Health , 2009, DOI: 10.1186/1475-9276-8-22
Abstract: Data on 4187 under-five children were derived from the Nigeria 2003 Demographic and Health Survey. Household asset index was used as the main indicator of socio-economic status. Socio-economic inequality in chronic childhood malnutrition was measured using the "extended" illness concentration and achievement indices.There are considerable pro-rich inequalities in the distribution of stunting. South-east and south-west regions had low average levels of childhood malnutrition, but the inequalities between the poor and the better-off were very large. By contrast, North-east and North-west had fairly small gaps between the poor and the better-off on childhood malnutrition, but the average values of the childhood malnutrition was extremely high.There are significant differences in under-five child malnutrition that favour the better-off of society as a whole and all geopolitical regions. Like other studies have reported, reliance on global averages alone can be misleading. Thus there is a need for evaluating policies not only in terms of improvements in averages, but also improvements in distribution.More than one-quarter of all under fives in the developing world are underweight [1]. This accounts for about 143 million underweight children in developing countries [1]. Of these 143 million underweight children, nearly three-quarters live in just 10 countries [1]. In Sub-Saharan Africa more than one-quarter of children under five are underweight. Nigeria and Ethiopia alone account for more than one-third of all underweight children in Sub-Saharan Africa [1]. Undernutrition, conversely, has been estimated to be an underlying cause for around half of all child deaths worldwide [2]. According to recent comparative risk assessments, under-nutrition is estimated to be, by far, the largest contributor to the global burden of disease [2,3]. Undernourished children have lowered resistance to infection and are more likely to die from common childhood ailments like diarrhoeal disea
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