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Utilization and factors associated with family-based index case testing for paediatric and adolescent HIV diagnosis in Mukono General Hospital
No full textThis thesis is submitted in partial fulfillment of the requirements for the award of a Master of Medicine in Paediatrics and Child Health of Makerere University.Introduction: Children in resource-limited settings remain undiagnosed and at substantial risk for HIV/AIDS-related mortality and morbidity. Identification of HIV-positive children is critical to their survival. Family-based index case HIV testing is an efficient high-yield approach where HIV-positive patients are screened to identify family members with unknown HIV status and offer them HIV testing services. However, despite its demonstrated effectiveness, family-based index case HIV testing remains inadequately scaled up and there is paucity of data regarding its utilization to guide policy and implementation. Objective: To assess the utilization level and factors associated with family-based index case HIV testing for children or siblings of HIV-infected index cases attending the ART clinic in Mukono General Hospital (MGH). Methods: This facility-based cross-sectional study was carried out at the ART clinic in MGH. Ethical approval was obtained from the School of Medicine Research and Ethics Committee, administrative clearance was obtained from MGH administration, and consent was obtained from all participants. We consecutively enrolled 467 HIV-positive index cases who were initiated on ART from January 2019 to December 2022 and had registered children/siblings. Data was collected using a pretested questionnaire. The level of utilization of family-based index case HIV testing was calculated and expressed as a percentage of index cases whose children/siblings had received HIV testing. Logistic regression was used to determine independent variables associated with the utilization of family-based index case HIV testing. Results: 476 index cases were enrolled in the study; the median age was 29 years with an Inter Quartile Range (IQR) of 22 – 35 years. Majority 347(72.9%) of them were female and more than half (52.5%) had a primary level of education. The level of utilization of family-based index client testing was 87.2% (95% CI: 83.9-89.9). The factors associated with increased utilization of index case HIV testing included; being female (AOR 2.18, p-value=0.011), non-viral load suppression (AOR 2.5, p-value=0.011), and being aware of index client testing services (AOR 2.9, p-value=0.022). Conclusion: This study highlights that the utilization of family-based index client testing at Mukono General Hospital was still lower (87.2%) than the target of 95% for epidemic control and end AIDS by 2030 Index clients who were females, those with a non-suppressed viral load and those who are aware of index client testing services were more likely to have tested their children/siblings. Addressing gaps in male involvement, continuous updates of the family tracking tool and line lists to identify and test those with unknown HIV status, and revision of health education for the suppressed patients may improve this picture.HEPI-SSHU,
Fogarty International Center of the National Institutes of Health,
U.S Department of State‟s Office of the U.S Global AIDS Coordinator and Health Diplomacy (S/GAC),
Presidents Emergency Plan for AIDS‟ Relief (PEPFAR) under award number 1R25TW0112131R25TW011213
Prevalence, practices and challenges of home management of pain among children with sickle cell anaemia attending Mulago Sickle Cell Clinic
No full textDissertation submitted in partial fulfillment for the award of the Degree of Master of Medicine in Pediatrics and Child Health of Makerere University.BACKGROUND
The most problematic aspect of managing sickle cell disease is the pain caused by vaso-occlusion . Despite a good follow-up of the patients, the vaso-occlusive crises remain unpredictable and have an uncertain evolution, most often requiring treatment with an analgesic agent at home before consultation with a healthcare provider. OBJECTIVE: To determine the prevalence, describe practices and challenges of home management of pain among children with sickle cell anemia attending Mulago sickle cell clinic. METHODS: This was a descriptive cross-sectional mixed methods study, conducted among children aged 3-17 years attending Mulago sickle cell clinic. Consecutive sampling was done until a sample size of 249 children was attained. Data was collected using a questionnaire and in- depth interviews were conducted. Quantitative data was entered into Epidata Version 4.6 then was exported to STATA College Station TX Version 14 for analysis. Qualitative data from in-depth interviews was analyzed manually using content thematic approach.
RESULTS:A total of 249 participants were enrolled in the study.The mean age of the enrolled participants was (9.7±3.9)years, with median weight (IQR) 24.2(19-32.7) kgs. More than a half were female 137.(55.1%).Of the 249 children who presented with pain 245(98.4%) managed pain at home before coming to the clinic. Majority 222(89.2%) of children used both pharmacological and non pharmacological practices to manage pain at home. 192(86.5%) took an analgesic for pain management. Paracetamol was the most frequently taken medication 67(30.2%) followed by ibuprofen 56(25.2%). For those that took paracetamol, about 21(31.3%) children took correct doses and frequencies of the drug and 46(68.7%) children took incorrect doses and frequencies. For those that took ibuprofen; 29(51.8%) children took incorrect doses and frequencies of the drug and 27(48.2%) children took correct doses and frequencies. A few number of children 23(9.2%) used non pharmarcological practices only to manage pain. Challenges of home management of pain included inadequate knowledge of drug doses, support from the caregivers’ partners, individual perceptions, drug stock outs and lack of health education for pain management at home from the health facility.
CONCLUSION AND RECOMMENDATION: Most children and adolescents with sickle cell anemia manage their pain at home before seeking medical attention. Nine out of ten use paracetamol and ibuprofen, often in incorrect dosages and frequencies. There is a need to improve education about using the correct dosages and use of safe non-pharmacological practices for managing pain at home
Factors associated with length of hospital stay among sickle cell disease patients at Nalufenya and Mulago National Referral Hospitals: A cohort study.
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirement for the award of Master of Public Health degree at Makerere University.Introduction: Children with Sickle Cell Disease (SCD) suffer multiple and often prolonged hospitalizations. Increased length of hospital stay for these children has negative psychological, economic and health effects on the children, care takers and the health system as a whole. On the other hand, reduced hospital stay is associated with benefits like reduced mortality rates and lower financial stress.
With the public hospitals in Uganda being congested, it is important to understand factors pertaining to the length of hospital stay among children with SCD. This study will therefore aim to estimate the length of hospital stay and its associated factors among children with sickle cell disease at both Nalufenya and Mulago National referral Hospitals (MNRH). Results from this study will enable stake holders to devise interventions to reduce hospital stay and subsequently reduce congestion of the hospitals, as well as to ensure well-being of the patients.
Methods: A prospective cohort study was conducted among 385 children with SCD who were admitted at Nalufenya Hospital and MNRH between 15th December 2022 and 15th April 2023. Data collection was by interviewer administered questionnaires, review of hospital records and physical examination. The Kaplan−Meier method and log-rank test were used to estimate the cumulative probability of hospital discharge by each categorical variable. The Cox proportional-hazards regression model with robust standard errors and clustered by health facility was applied to determine the potential risk factors associated with length of hospital stay
Results: Of the 385 study participants, 53.8% were male, while 46.2% were female. The mean age was 6.9 (±3.8) years while the median was 7.0 (4.0, 10.0) years. The mean length of hospital stay among children with SCD at Nalufenya Hospital and MNRH was 6.3 (±4.3) days, the median LOS was 5 (5 - 6) days. Children with secondary complications had the highest average LOS days of 11.5 (± 10.1) followed by children with severe malnutrition 10.3 (± 7.7). At multivariable analysis, a good nutritional status was associated with a shorter length of hospital stay (AHR 2.43, [95% CI: 1.86 – 3.18]), while factors less likely to be associated with a shorter length of hospital stay included acute chest syndrome (AHR 0.49, [95% CI: 0.43 – 0.57]), presence of secondary complications (AHR 0.35, [95% CI: 0.18 – 0.68]) and the child’s caretaker being a biological parent (AHR 0.74 [95% CI: 0.58 – 0.95]).
Conclusions: The average LOS among children with sickle cell disease admitted at Nalufenya Hospital and MNRH is 6.3 (± 4.3) days. The factors associated with length of hospital stay among children with sickle cell disease at Nalufenya and Mulago National Referral Hospitals include; nutrition status, the type of crisis, co – infection, and care taker’s relationship with the patient.
Recommendations: Streamlined care plans need to be made for children admitted with sickle cell disease to cater for improvement in nutrition status, pain management, and management of existing infections among the patients
Strategic human resource management, employee engagement and employee performance: a cross-sectional study of employees at Kampala Capital City Authority, Uganda
No full textA dissertation submitted to the School of Psychology in partial fulfilment of the requirements for the award of a Masters of Organization Psychology Degree of Makerere UniversityThe purpose of this study was to investigate the relationship between Strategic Human Resource Management, Employee Engagement and Employee Performance among employees at Kampala Capital City Authority. A simple random sampling strategy was used to select 140 respondents. A correlation research design was employed, Pearson correlation coefficient was used to test the first three hypotheses, while Kenny and Baron Regression Analysis (1986) was used to measure the fourth hypothesis. The study findings indicated a significant positive relationship between Strategic Human Resource Management (SHRM) and employee engagement. The study also revealed that employee engagement has a significant positive relationship with employee performance. A significant positive relationship was also found between Strategic Human Resource Management and Employee Performance. It was also found that employee engagement does not mediate the relationship between Strategic Human Resource Management and Employee Performance. Organizations that need to keep competitive advantage (performance) should focus on improving SHRM and Employee Engagement
Family socioeconomic status, social support, and postpartum depression among adolescent mothers in Wakiso District
No full textA research dissertation submitted to the School of Psychology in partial fulfillment for the requirements for the award of a Degree in Masters of Science in Clinical Psychology of Makerere University.The study aimed to investigate the relationship between family socioeconomic status, social support, and postpartum depression among adolescent mothers. A purposive sampling strategy was used in the selection of 171 adolescent mothers from Wakiso district Nansana division, Nabweru health center 3 and data was collected using the Asset register, the multi-dimensional scale of perceived social support and the Edinburgh Postnatal Depression Scale. A correlational research design was employed and Chi-square was used to examine the first three study hypotheses and then the PROCESS macro analysis was used to test the fourth hypothesis. The results of this study indicated while social support was significantly associated to postpartum depression (X2 (1, n=171) = 8.747, p0.05), although there was a significant association between family socioeconomic status and postpartum depression (X2(1, n=171) = 14.005, P < 0.005). when it came to the fourth hypothesis, the interactive effect of family socioeconomic status, social support and postpartum depression were significant 0.007. In conclusion, this indicated that demonstrating participants from lower socioeconomic strata (lowest quintile) are more likely to experience postpartum depression compared to those from higher strata (highest quintile). Sensitization on the benefits of social support from all sources and in all forms may buffer the negative effects of postpartum depression on the adolescent mothers
The effects of traditional and non-traditional agricultural exports on income per capita in Uganda (1988-2021)
No full textA dissertation submitted to the Directorate of Graduate Research and Training in partial fulfilment of the requirements for the award of a Degree of Master of Arts in Economic Policy and Planning of Makerere UniversityThis study set out to investigate the empirical relationship between traditional and non-traditional agricultural exports on income per capita in Uganda using time series data obtained from World Bank (World Development Indicators) and Uganda Bureau of Statistics for the period between 1988 and 2021. The objectives of the study were; to investigate how traditional and non-traditional agricultural exports affect income per capita in Uganda and how fish and coffee exports affect income per capita in Uganda. The study adopted both the Augmented Dickey Fuller (ADF) and Phillips Perron (PP) tests to ascertain the order of integration of the variables. The unit root test results revealed a mixture of order zero I(0) and order one I(1) variables. The ARDL results indicated; in the short run, a 1% increase in non-traditional agricultural exports leads to a 0.0263% increase in gross domestic product per capita at the 1% level of significance. A 1% increase in traditional agricultural exports leads a 0.0344% increase in gross domestic product per capita at the1% level of significance. Coffee exports are statistically significant at the 10% level of significance whereby, a 1% increase in coffee exports leads to a 0.015% increase in gross domestic product per capita. Fish exports are statistically significant at the 10% level of significance. A 1% increase in fish exports leads to a 0.0136% increase in gross domestic product per capita. In the long run, traditional agricultural exports are statistically significant at the 1% level of significance whereby, a 1% increase in traditional agricultural exports leads to a 0.358% increase in gross domestic product per capita. Non-traditional agricultural exports are statistically insignificant. A 1% increase in coffee exports leads to a 0.1614% increase in gross domestic product per capita at the 10% level of significance. A 1% increase in coffee exports leads to a 0.037% increase in gross domestic product per capita at the 1% level of significance. Fish exports is statistically significant at the 5% level of significance whereby, a 1% increase in fish exports leads to a 0.0230% increase in gross domestic product per capita. The study recommends policies that are geared towards increasing income per capita. Specifically, increasing the supply of fish for international, adding value to non-traditional agricultural exports, design a population growth strategy combined with institutional and policy changes to ensure population growth, encourage education through provision of free or subsidized education and introducing modern production technologies of coffee to upgrade the traditional methods
Geometric design of Katalemwa road (KCCA Projects).
No full textA project report submitted to Makerere University Directorate of Research and Graduate Training as a requirement in partial fulfillment for the requirement of the award of a Post Graduate Diploma in Construction Management of Makerere University.The report gives an account of the Detailed Engineering Design (DED) of Greater Kampala Metropolitan Area (GKMA) lot 3 roads- [Old Kireka Road, Bukoto Street, and Katalemwa roads] which included geometric design activity in line with project management; The report focused on geometric design, project management, and contract administration. This report also gives details of activities carried out during the implementation of the design project and describes the author’s involvement in the project as a CAD operator
on the Consultant’s side
Examining employee turnover in outsourcing companies. A case study of ISON BPO Uganda Limited
No full textThis research study examines employee turnover in outsourcing companies using the case study of ISON BPO Uganda Limited. The study aimed to identify the drivers of employee turnover, examine the impact of turnover, and recommend strategies to mitigate it. The study used a case study research design and employed a quantitative research approach. It targeted
a sample size of 200 respondents and achieved a response rate of 100%. Data was collected using a questionnaire.
The findings on the drivers of employee turnover reveal that employees tend to disagree with the statement that compensation and benefits are competitive in the industry. The results also indicate that majority of respondents were dissatisfied with their workload and job responsibilities. Majority also disagreed with the statement that Work-life balance is effectively supported in the company, they perceived their workload and expectations to be unrealistic and were generally dissatisfied with the overall work environment and office facilities but there was agreement on the organisational culture promoting a sense of belonging and the existence of communication transparency as well as supervisors being supportive and providing the necessary guidance while mixed perceptions were recorded on the company providing opportunities for professional growth and getting recognition for their contributions.
The study findings on the effects of employee turnover on outsourcing companies revealed that respondents strongly agree that high employee turnover negatively affects the overall performance of the company, client relationships are negatively affected as well, and the cost of recruitment and training associated with high turnover is a burden to the company. The respondents agreed that high employee turnover has a negative impact on company profitability, and that the retention of top talent is difficult in companies that are characterised by high employee turnover, difficulty meeting project deadlines also garners significant agreement. Employee morale and job satisfaction are notably affected, as most respondents strongly agree. Majority of the respondents were however unsure if the company has a formal retention strategy in place. Finally, the study findings suggest strategies to mitigate employee turnover. Respondents strongly endorse offering competitive compensation and benefits packages, professional growth and development opportunities within the company, a supportive and inclusive work
environment, alignment of training and development with employee needs, clear career progression paths, and active encouragement of employee feedback. They also recommend reasonable and manageable workloads, work-life balance and flexible work arrangements should be considered, effective communication channels, and recognition and rewards for outstanding performance
Information-seeking behaviour of art and design students in diploma-awarding institutions in Uganda
No full textA Dissertation submitted to the Directorate of Research and Graduate Training in partial fulfilment of the award of the Degree of Doctor of Philosophy in Information Science of Makerere University.This study sought to establish the information-seeking behaviour of Art and Design students in diploma-awarding institutions in Uganda, in order to propose a model of information-seeking behaviour for Art and Design students. Specifically, the study sought to: (i) establish the information needs of Art and Design students, (ii) establish the sources of information used by Art and Design students, (iii) determine the information-seeking strategies used by Art and Design students, (iv) identify the challenges (if any) Art and Design students encounter when seeking information, and (v) propose an information-seeking behaviour model for Art and Design students. The study population comprised Art and Design diploma students, library heads, and directors at the National Council for Higher Education. Data was collected using questionnaire, interview, and observation methods. Quantitative data was analysed using the Statistical Package for Social Sciences while qualitative data was analysed thematically.
The study revealed that the information needs of Art and Design students were principally related to their academic activities (creation of artworks). The most needed information included information on: employment opportunities in the art and design industry; production materials for art and design products; tools and equipment for art and design products; art markets and sales for art and design products; production techniques for art and design products; computer graphic design programs; and on art and design industries for internship placements.
The study found that Art and Design students used varied sources of information, with the visual resources being predominant. The most used sources included art and design lecturers, images, artists and designers, YouTube, nature and the environment, and art documentaries. The study also revealed that Art and Design students used various information-seeking strategies to locate and access information. Browsing online images, photographing activities in the environment, recording videos of activities in the environment, and consulting Art and Design librarians were prevalent strategies. In addition, the study found that the students encountered varied challenges when seeking information, primarily related to the Internet and library system, including lack of Internet connectivity at the institutions, high cost of Internet data, inadequate relevant and outdated information materials in the library. The study recommended that the study institutions should: (i) invest heavily in the ICT infrastructure, including Internet connectivity, (ii) provide access to a variety of quality visual information resources, such as images; and that the Government of Uganda should subsidize Internet in the study institutions.
Optimizing detection and early management of acute kidney injury using trained caregivers on the infectious disease wards of Kiruddu National Referral Hospital
No full textA dissertation submitted to the Department of Medicine in partial fulfilment of the requirements for the Award of the Degree of Master of Medicine in Internal Medicine at Makerere University.Background: Globally 13.3 million people develop AKI annually, with 85% in LMICs, largely due to infections and sepsis. AKI can be resolved in up to two-thirds of the patients with proper timely management. Current clinical practice rarely uses urine output (UO) monitoring since it is tedious. Due to limited human resources in low and middle-income countries (LMICs), informal active involvement of patient caregivers has proved beneficial. In this study, we used a quality improvement (QI) approach by training caregivers in UO monitoring to optimize the detection and early management of AKI through a task-shift model. Methods: A quasi-experimental pre-post intervention study with a six-month retrospective data review of randomly sampled 121 patient files was done for AKI diagnosis and related outcomes among patients who were admitted on the infectious disease (ID) wards of Kiruddu National Referral Hospital (KNRH) to generate pre-intervention data. The same data was prospectively collected in a review of 119 patient files on the same wards for eight weeks during the implementation of the QI interventions. The QI interventions were implemented in two phases: 1) clinical staff education on AKI detection and early management, and 2) training caregivers on UO monitoring respectively to generate trends in AKI diagnosis. We used Pearson’s chi-square test and Fisher’s exact test to determine trends in UO monitoring and the prevalence of diagnosed AKI during the pre-intervention phase and the two phases of QI intervention. Multilevel models using mixed effects logistic regression were used at a 5% significant level to estimate odds ratios [ORs] for hypothesized correlates of QI interventions. Results: In the pre-intervention phase, 60% of participants were female with a median age of 37 years (IQR: 28-47). During the QI interventions, 36% of participants were female with a median age of 38 years (IQR: 29-48). During the pre-intervention phase, AKI was diagnosed in 12% of cases without UO monitoring. In the first phase of the QI intervention, UO monitoring increased to 12%, and AKI diagnoses rose to 25%. In the second phase, UO monitoring reached 62%, with AKI diagnoses at 31%. Overall, during the QI interventions, UO monitoring increased to 40%, and AKI detection rose to 29%, with 91% of those diagnosed receiving management. Mortality significantly decreased from 41% at baseline to 15% (P < 0.001). Conclusion: Routine clinical practice has less AKI detection.Trained caregivers in UO monitoring, using a multicomponent QI approach, optimized AKI detection and early management on KNRH's ID wards.The QI project was associated with a reduction in mortality on the ID wards of KNRH