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Prevalence and factors associated with chronic pulmonary aspergillosis among post tuberculosis lung disease patients at Makerere University Lung Institute
No full textIntroduction: As of 2021, there were around 10.6 million incident cases of tuberculosis (TB) worldwide, listing it as the leading cause of infectious-related death worldwide. Despite receiving a microbiological cure, approximately 50% of TB survivors experience mild to severe permanent lung impairment. Post-Tb lung disease (PTLD) can be complicated by infections of which the most severe is chronic pulmonary aspergillosis (CPA) that is a worry for many TB survivors worldwide, including the nearly 50,000 persons registered in 2021 in Uganda. The misdiagnosis of CPA as relapsing TB and the limited priority public health action, portrays that its gross mortality and morbidity are underrecognized. Moreso, the limited number of studies exploring its burden and associated factors cannot inform and sustain public health policies locally and globally.
Objective: This study sought to determine the prevalence and factors associated with CPA among PTLD patients at Makerere University Lung Institute (MLI).
Methods: This was a cross-sectional study that used the medical records of 219 patients with PTLD diagnosis at MLI from January 2018 to April 2023. The records were selected by consecutive sampling. The dependent variable was presence of CPA and the independent variables were socio-demographic and clinical characteristics. The data was entered into Epidata and exported to STATA for analysis. The association between the dependent variable and the independent variables was assessed using modified Poisson.
Results: The prevalence of CPA was 33.8% (CI: 27.6-40.5), was higher in those aged between 45 and 60 years (42.4%, CI: 30.3-55.2) and spread throughout the duration from TB treatment: 10years 28.9% (CI: 19.82-39.40). Nonprofessional work (PR-1.74 CI: 1.21-2.50), Multiple TB episodes (PR-1.97, CI: 1.37-2.84), HIV (PR-0.5, CI: 0.3-0.84), bronchiectasis (PR-1.96, CI: 1.42-2.72), cavities (PR-1.96, CI: 1.3-2.95) and unilateral lung damage (PR-2.05, CI: 1.30-3.24) were significantly associated with CPA.
Conclusion: This study showed that nearly four in every ten PTLD patients had CPA, with potential for manifestation any time after TB treatment, even beyond a decade later. CPA presentation implies pre-existing lung damage suggesting that the lung damage in PTLD patients could be chronic/permanent making them at risk of CPA throughout their life. Most CPA patients were below 60 years highlighting concerning consequences for their productivity, health related quality of life and overall development. Routine follow up of PTLD patients for CPA screening is highly recommended with specific emphasis on those with cavities, bronchiectasis, HIV and nonprofessional workers such as industrial workers, famers
Effect of digital financial innovations on financial inclusion in Uganda
No full textA research report submitted to the Directorate of Research and Graduate Training in Partial fulfilment of the requirements for the award of Master of Arts in Economic Policy Management degree of Makerere UniversityThe study examines the effect of digital financial innovations on financial inclusion in Uganda using secondary data from the World Bank Global Findex Data of 2021 on financial inclusion. Specifically, the study examines the extent to which mobile money services affect financial inclusion, assesses the effect of Internet banking on financial inclusion, and examines the impact of Automated Teller Machines on financial inclusion. The study modelled other socio–demographic characteristics such as age, gender, education, employment and income quintile. The study employs a simple probit model to study the effect of digital financial innovations on financial inclusion. The study finds that access to mobile money services, Automated teller Machines, and Internet banking services are significant determinants of financial inclusion. Access to these financial innovations affects an individual’s usage of financial services. For instance, Mobile phones, ATMs and Internet banking access tend to induce the usage of financial services by providing financial services to the unbanked population in areas where operating banks are not accessible. Findings also indicate that education, employment and income quintile play a significant role in influencing an individual’s level of financial inclusion, as those with formal education are more likely to have access to financial education and have higher financial literacy levels, which can help enhance decision making relating to financial issues such as savings or borrowing. Other demographic factors, such as age and gender, do not significantly affect financial inclusion. The study recommends that telecom operators and the banking sector should constantly provide digital financial services since they all significantly deepen financial inclusion in Uganda
Prevalence and outcomes of gastrectomy at Mulago National Referral Hospital; A cross-sectional study
No full textBackground: Gastrectomy is a surgical procedure performed for various conditions of the stomach and duodenum. Despite its widespread use, there needs to be more data reporting in-hospital outcomes associated with gastrectomy in our healthcare setting. This study investigated gastrectomy's prevalence and in-hospital outcomes and factors related to these outcomes at Mulago National Referral Hospital (MNRH) from January 2012 to April 2023.
Methodology: This retrospective cross-sectional study reviewed medical records of patients who underwent surgery for diseases of the stomach and duodenum at MNRH between January 2012 and April 2023. A total of 274 were found to have undergone surgery for diseases of the stomach and duodenum of which 78 were gastrectomy. Therefore, seventy-eight files were evaluated for morbidity and mortality post-gastrectomy. Data was collected and then analyzed using STATA version 17. Pearson’s chi-square, bivariate, and multivariate logistic regression were used for gastrectomy outcomes to explore associations between independent variables and gastrectomy outcomes.
Results: Gastrectomy accounted for 29.9% of all surgeries done for diseases of the stomach a duodenum during the study period. The commonest indication for gastrectomy malignant disease (74.4%). The mortality rate post gastrectomy was 10.3%, while the morbidity rate was 32.8%. The most common complications were surgical site infections (23.1%), gastrointestinal obstruction (15.4%), and anastomotic leaks (6.4%). Prolonged surgery time (>4 hours), the presence of malignancy, and developing post-operative gastrointestinal obstruction were found to be independently associated with postoperative morbidity and mortality.
Conclusion:
The number of gastrectomies for diseases of the stomach and duodenum is much lower in Uganda than in the rest of the world. Mortality and morbidity post gastrectomy remain higher in Uganda and other LMICs than in high-income countries.
We recommend a more extensive and prospective study to address the challenges created by the study's retrospective nature. Early diagnosis of the diseases of the stomach and duodenum while they are still amenable to curative surgery like Gastrectomy. Measures should be put in place to prevent and or quickly identify post-gastrectomy complications to reduce morbidity and mortality rates
Organizational culture and innovativeness of academic staff at Kyambogo University
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirements for the award of a Doctor of Philosophy in Educational Management of Makerere University.The purpose of the study was to investigate how organizational culture dimensions impact on the innovativeness of academic staff at Kyambogo University. Based on Hofstede’s theoretical model of organizational culture, specifically the study determined the extent to which organizational culture variables namely; Uncertainty Acceptance, Power Distance and Collectivism could explain the innovativeness of academic staff in Kyambogo University. Under each of these variables, apart from the existence of the culture the focus was also on how leadership promoted that particular culture to support the innovativeness of academic staff. To explore whether organizational culture predicted innovativeness of academic staff, a mixed approach was adopted. Data was collected using survey and interview methods. On the quantitative side, data was collected from a sample of 186 academic staff of the university, which data was analyzed using Descriptive statistic such as the means, correlation and multiple linear regressions, Confirmatory Factor Analysis(CFA), Cronbach alpha, means and multiple linear regressions. Qualitative data was collected purposively from 16 participants, and this data was analyzed through forming codes, categorizations and thematic analysis to derive meaning on the variables under my study. Findings revealed that organizational culture (ie, Uncertainty Acceptance), and leadership support to maintain a culture of power distance were positive predictors of Innovativeness of Academic Staff (IAS). Leadership support for the culture of uncertainty acceptance, culture of power distance, culture of collectivism, and leadership support for the culture of collectivism were not positive predictors of IAS. Power Distance and Collectivism of the University were positive predictors of Innovativeness of Academic Staff (IAS). Summative thematic analysis revealed that; opportunity exploration, idea generation, idea championing and idea implementation were perceived as crucial factors for enhancing innovativeness of academic staff. The study thus, concluded that innovativeness of academic staff depended on culture of Uncertainty Acceptance and leadership support to maintain a culture of power distance. It was thus, recommended that authorities in Kyambogo University need to pay attention on predictors of innovativeness of academic staff, namely; Uncertainty Acceptance, Power Distance and Collectivism promote the culture of uncertainty acceptance and support a culture of power distance
Adoption to improved cassava varieties, production and post-harvest management in Uganda
No full textA dissertation Submitted to the Directorate of Research and Graduate Training in partial fulfilment of the requirements for the award of the degree of Doctor of Philosophy in Economics of Makerere University.This dissertation addresses three key fundamental objectives that are aimed at providing some insights about the performance of the cassava sub-sector. First, it examines the role of agricultural extension services in the adoption of improved cassava varieties in Uganda (chapter 3). Second, an assessment of the effect of improved cassava varieties on cassava production in Uganda (chapter 4). Third, it examines the causes of post-harvest losses in cassava sub sector, the stage at which post-harvest losses occur at household level and the strategies used by farmers to reduce the post-harvest losses in the same enterprise (chapter 5).
In examining the role of agricultural extension to the adoption of improved cassava varieties in Uganda, the study used farmers who reported accessibility to agricultural extension from extension workers about such improved varieties and a probit with selection equation were employed on data collected from eight (8) districts in Northern Uganda. In chapter four, the study employs interrupted time series analysis to provide evidence of the impact of cassava varieties on cassava production in Uganda. To examine the causes of post-harvest losses in cassava sub sector, probit estimations were used to determine the factors leading to post-harvest losses at the household level. The main results from the three chapters are: (1) there is a higher probability of adopting improved cassava varieties when farmers access agricultural extension services; and also document farmers’ distrust to improved cassava varieties as a crop enterprise that can guarantee their households with food security; (2) improved cassava varieties contribute to increased cassava production in the country and (3) post-harvest losses occur due to absence of storage facilities, pest invasion and lack of market information. The study provides evidence that post-harvest losses occur at different stages even within a single household and too, households use differing strategies to reduce on post-harvest losses. From the policy perspective, the results suggest that the design and content of improved agricultural technologies requires supporting interventions such as agricultural extension services and interventions aiming at promoting food security and poverty eradication especially within rural households need to supplement the efforts with enhanced mechanisms for post-harvest handling
Assessing the effect of results-based financing on the maternal, newborn, and child health indicators for a community health program in Kyotera District, Uganda
No full textBackground: The study recognizes the pressing need for improved Maternal, Newborn, and Child Health (MNCH) outcomes in Uganda, where a significant number of women still receive limited antenatal care and give birth outside of healthcare facilities. These factors contribute to alarmingly high maternal and infant mortality rates. Results based financing (RBF) has been proposed as a financing a mechanism that can motivate providers to deliver both improved quantity and quality of services. Despite this potential of RBF, there is inadequate documented evidence and limited robust evaluations on its effectiveness in different contextual settings.
Method: A case study design utilizing mixed methods approach was employed to assess the effect of community health Results Based Financing intervention. The quantitative approach was based on a single interrupted time series using secondary data collected by community health workers from June 2017 to December 2019. A qualitative approach of data collection was used, key informant interviews, and document review were used as primary data collection methods. The data collected using interviews, and document reviews was analyzed using thematic analysis techniques.
Results: Preliminary findings indicate notable improvements in MNCH indicators. Following RBF implementation, pregnant women delivering at health facilities and malaria treatment cases for children under-five years experienced substantial increases. RBF led to increased emphasis on pregnancy care visits, which in turn improved antenatal care visits, health facility deliveries, and postnatal care visits. Stronger relationships with health facilities also contributed to a significant increase in health facility deliveries.
Conclusions: This research provides robust evidence of RBF's positive impact on MNCH outcomes. The results underscore the importance of training, community sensitization, data verification. However, challenges related to data verification and incentive structures warrant further consideration in future RBF interventions to optimize their effectiveness and sustainability
The construction of subcounty administration block in KOCHEKA subcounty, Bukedea district
No full textA technical report submitted in partial fulfilment for the award of Masters in Construction management of Makerere UniversityThis report is about the Construction of the Administration Block for Kocheka Sub County in Bukedea District, under which the author participated as Project Manager on the Clients’ side. Detailed construction approach employed and aspects of construction project management practice adopted during the execution phase are also included in the report. The areas discussed at length include the measures I took to ensure the project objectives in terms of cost, quality, time, safety, and environmental aspects were achieved during the execution of the project.
By the time of writing this report, construction works had been concluded, and the project handed over. This project was funded by the Government of the Republic of Uganda at a contract price of TWO HUNDRED SIXTY-FIVE MILLION, FOUR HUNDRED NINETY- SEVEN THOUSAND SEVEN HUNDRED FORTY-THREE SHS (265,497,743 Uganda Shillings), the major objective of the project was to provide decent accommodation for Offices for the Sub County Staff. The contract (ad-measurement) was awarded on February 23rd, 2023, and it took a duration of 3 months to complete.
This report therefore covers the period from contract award to finishes and handover of the project. Generally, the execution and management of this project was a success. Gantt charts were used to manage and control time as concentration was always given to critical activities. Quality was achieved by following standards, specifications, work methods, and close supervision. Costs were also managed through timely resourcing of the activities using the rates provided for the activities. The author ensured the proper involvement of all stakeholders in
the project and the smooth flow of information during the period of project execution
On completion of the project, I noted that, for timely completion of the project, there should be;
Adequate financial resources as per the project estimated cost, Skilled manpower as demanded by the various tasks, Both the contractor and the client should be interested in the project, Site diaries should be used on site, this helps in variation claims and extension of time.
And for Quality Control; It’s always important to have the clerk of works on site, Material test results have to get submitted before the contractor uses a given material, For manufactured materials, it’s important to have a certificate of supply, this will exonerate the supervisor in case of defects after the defect’s liability period, Material testing should always be done by the clients’ team; this helps in the avoidance of compromise, Regular inspection of works, helps in early detection of unwanted works, and hence early remedy, Do not allow influence from the client to pay for un done works, for the contractor will not do as per the standard and it makes its enforcement very difficult.
For Cost Control, one should adhere to the following; Savings within the quantities can be transferred to meet unforeseen items, careful instructions be issued after assessing the cost implications, it should be only the authorized technical person to issue instructions, and record of payment should be properly kept, take off sheets are a must in any project.
For Time Control, one should observe the following; Ensure that the contractor produces a work schedule in the form of a Ghant chart, Critical activities should be properly spelt of and properly plan for their execution.Sel
Determinants of willingness to pay for briquettes in Uganda
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirements for the award of the degree of Master of Agribusiness Management of Makerere University.This study, conducted in Kampala, Uganda, aimed to determine the willingness of briquette users to pay for this alternative energy source. The overall objective was achieved through three specific objectives: characterizing different energy sources, estimating consumer willingness to pay for briquettes, and determining the influencing factors. The research was carried out in the five divisions of Kampala Capital City Authority; Makindye, Kawempe, Rubaga, Nakawa and Kampala central. The study population comprised of energy users comprising of household consumers, institutions and business ventures from each division. The study area was purposively selected because of heavy reliance on biomass energy especially for cooking. A total of 200 respondents were sampled. In each of the five divisions of Kampala data collection was conducted in four wards which were randomly selected. From each ward one village/zone was also randomly selected and from each villages/zones, 10 respondents were randomly sampled from the different households and interviewed. Methods employed for data collection included structured questionnaires and individual one-on-one interviews. The study revealed significant findings regarding the determinants of consumer willingness to pay for briquettes. Key influencing factors identified were age, profession, monthly income, briquette type (specifically carbonized), and the current use of wood or charcoal as the primary source of fuel. To achieve objective one descriptive statistics were computed. These included means, standard deviations, percentages and frequencies and F statistics. Objectives 2& 3 were achieved using double bounded dichotomous choice contingent valuation for willingness to pay models. The ordered probit model was used to analyze objective three. Estimates of the parameters of this model was by maximum likelihood estimation. The findings indicated that younger individuals demonstrated a higher willingness to pay for briquettes, suggesting a potential generational preference for cleaner energy sources. Professionals were also more inclined to adopt briquettes, possibly due to higher income levels, environmental awareness, or convenience. Monthly income was identified as a crucial determinant, with higher income levels positively correlating with increased willingness to pay. Moreover, the type of briquette used influenced consumer preferences, with carbonized briquette users exhibiting a higher willingness to pay. The study also found that consumers currently relying on wood or charcoal as their main fuel sources were more receptive to adopting briquettes. In conclusion, the study provides valuable insights into the socio-economic and demographic factors shaping consumer willingness to pay for briquettes in Kampala. The identified determinants offer strategic implications for targeted marketing, income-sensitive pricing strategies, and policy recommendations to promote the widespread adoption of briquettes as a sustainable energy alternative in Uganda
Implementation of the revised re-entry guidelines for teenage mothers into secondary school post-COVID-19: Stakeholders' experiences and lessons in Mbale District, Uganda
No full textBackground: The Ugandan government enacted the revised re-entry guidelines that included the re-entry aspect after an increase in the number of cases of teenage pregnancies as a result of school closures brought on by the COVID-19 pandemic. Only 8% of girls who dropped out of school were allowed to re-enroll although the re-entry guidelines were in place.
Objective: To explore stakeholders’ experiences regarding the implementation of the revised re-entry guidelines for teenage mothers into secondary schools post-COVID-19.
Methodology: A Phenomenological study was conducted in five secondary schools in Mbale city and district between June and July 2023. It was conducted using qualitative approaches such as in-depth interview guides with teenage mothers and key informant interviews with district leaders and school administrators to gain insight into how the revised re-entry guidelines were being utilized for the benefit of teenage mothers in secondary schools with a small component of quantitative data using a data extraction tool. Data were collected from 20 re-enrolled teenage mothers, 4 district leaders and 6 teachers. Data was analysed using Atlas. ti 9 which involved labelling texts with different code group names. Codes were then linked to form categories from where themes were generated, and results were reported based on themes.
Results: The majority of the teenage mothers’ re-entry into school was influenced by parental and school support post-COVID-19. Despite the existence of the re-entry guidelines the barriers that affected teenage mothers’ re-entry into school included stigmatization and peer discrimination, dual responsibility and time management. There was no data at the district level related to teenage mothers’ re-entry although some data was obtained from schools visited, there were a lot of gaps and missing information as the majority of schools lacked systematic tracking and documentation of teenage mothers’ re-entry for the past four years. Head teachers and senior women teachers were not trained on the re-entry guidelines as the majority were oblivious to their specific roles and the majority of schools did not have a copy of the re-entry guidelines for reference.
Conclusion: District leaders acknowledged inadequate dissemination of the re-entry guidelines in schools although some data was obtained from schools with a lot of gaps and missing information, no documentation of teenage mothers' re-entry. Therefore, the responsible stakeholders at the district who were tasked to compile and conduct regular evaluations should re-emphasize the importance of this data for decision-making for the benefit of teenage mothers.
Special attention is crucial for teenage mothers in schools in the form of continuous psychosocial support after re-entry into school
Predictive model of determinants of under-five child mortality in Uganda: A multilevel analysis approach
No full textA dissertation report submitted to School of Public Health, Department of Epidemiology and Biostatistics as partial fulfillment for Masters Of Biostatistics, College Of Health Sciences Makerere University.Introduction:
One of the primary priorities and targets of the Sustainable Development Goals (SDGs) for 2030 is to reduce under-five mortality to 25 deaths per 1000 live births in sub-Saharan countries. However, Uganda continues to experience a high under-five child mortality rate of 40 deaths per 1000 live births, which is almost double the SDG target. Although interventions to address under-five child mortality have largely focused on the individual child level, potential variations at the household and community levels have received limited statistical exploration.
Objectives:
This study aims to investigate the unaccounted-for variability in under-five child mortality, considering factors at the household and community levels. Additionally, the study aims to develop a predictive model for under-five child mortality in Uganda.
Methodology:
Using the 2016 Uganda Demographic and Health Survey (UDHS) dataset, a cross-sectional design was employed. The analysis included a sample of 15,522 live births that occurred within the five years prior to the survey. The outcome variable was binary, indicating whether a child died before the age of five (1) or survived (0). Standard logistic regression was used to examine individual-level factors associated with under-five child mortality, while mixed-effect logistic regression was utilized to account for nested data levels. A random forest model was developed to predict under-five child mortality in Uganda. Univariate analysis assessed variable distribution, and variables with a p-value <20% at the bivariate level were considered for the multivariable analysis. Adjusted Odds Ratios (AOR) with a p-value less than 0.05 were deemed significant determinants of under-five child mortality. Model selection was guided by the AIC and BIC criteria, and Intra-Class Correlation (ICC) and Likelihood Ratio Test (LRT) were used to evaluate cluster-level variation.
Results:
The findings revealed an under-five child mortality rate of 52 deaths per 1000 live births. Significant determinants of under-five child mortality included being a male child (AOR = 0.74), birth order (BO), BO 2-4: AOR=0.72, BO 5-7: AOR = 1.05, BO 8+: AOR = 1.65), mother's education (primary: AOR = 0.74; secondary: AOR = 0.66; higher level: AOR = 0.58), antenatal visitation (1-4 times: AOR = 0.32; 5+ times: AOR = 0.27), and contraceptive use compared to non-use (AOR = 0.63). The Random Forest model exhibited superior predictive performance with accuracy (95%), sensitivity (95%), precision (99%), F-score (98%), and an AUROC of 0.8490 compared to the statistical model. Variation in under-five child mortality was observed at the community level, accounting for 16.9% of the variance (ICC = 0.049).
Conclusion:
This study highlighted the existence of community-level variation in under-five child mortality. Significant determinants include maternal education, contraceptive use, child sex, and antenatal visitation. The Random Forest model emerged as the optimal predictive tool for under-five child mortalityHope4Kids Internationa