1,721,017 research outputs found
Access to health care for febrile children in Uganda: symptom recognition, care seeking practices and provider choice
No full textThis thesis is the basis for a joint degree of Doctor of Philosophy (PhD) between Karolinska Institutet and Makerere UniversityBackground: Febrile illnesses including malaria and pneumonia are leading causes of death among children under five in Uganda. Despite government efforts to increase health care access by offering free services at government facilities, the majority of the sick children receive care after 24 hours, often with less efficacious drugs. one of the strategies suggested for increasing access is the distribution of antimalarials and antibiotics at community level. However, determinants on access to health care for febrile children are not sufficiently understood. Main aim: The aim of this study was to assess the factors associated with access to treatment for febrile children under five in order to inform the implementation of child survival interventions at community level. Methods: Four studies were conducted in Iganga-Mayuge Demographic Surveillance Site in Eastern Uganda (I-IV). Study used key informant interviews (KIIs) with eight health workers and eight traditional healers and five focus group discussions (FGDs) with mothers of children under five. Study II was a cross sectional survey of 9,176 children under five. Study III was a survey of a random sample of 1078 households with children under five. Study IV used four FGDs with fathers and mothers of children under five and eight KIIs with health workers in government and Non-Governmental Organization facilities, community medicine distributors (CMDs), and attendant in drug shops and private clinics. Content analysis was used for qualitative data. Quantitative data was analysed at univariate, bivariate and multivariate levels to determine the independent predictors of delayed care or choice of provider. Results: There is general lack of knowledge on antibiotics as first treatment for fever with pneumonia symptoms (I) and use of less efficacious drugs for malaria acquired from the open market (IV). Caretakers prefer health care providers with a variety of drugs and able to do diagnostic investigations (IV). Two thirds of the caretakers consult the private sector and 27% of them among other things because they can get treatment on credit (III). There are diverse perceptions on drug efficacy among caretakers (IV). Being of low socio-economic status (OR 1.45; 95% CI 1.06┤1.97) and presenting with pallor (OR 1.58; 95% CI 1.10-2.25) are associated with delay in care seeking >24 hours after onset. Children seeking care outside the home <24 hours had fast breathing (OR 0.75; 95% CI 0.60-0.87), had had tepid sponging (OR 0.43; 95% CI 0.27-0.68), had provider proximity (OR 0.72; 95% CI 0.60-0.87) and went to drug shops (OR 0.70; 95% CI 0.59-0.84) or CMDs (OR 0.33; 95% CI 0.15-0.74) (II). Caretakers more likely went to government facilities when children had vomiting (OR 2.07; 95% CI 1.10-3.89), or when expecting qualified (OR 10.32; 95% CI 5.84-18.26) or experienced workers (OR 1.93; 95% CI 1.07-3.48). Caretakers went to private providers when seeking treatment as "first aid" (OR 0.20; 95% CI 0.08-0.52) (III). Discussion: Caretakers should be sensitized on recognition of symptoms for pneumonia, prompt care seeking and use efficacious drugs. CMDs should be able to do some diagnostic investigations and have constant drug supply. Using drug shops and private clinics in community interventions could complement government efforts to deliver timely treatment. Keywords: fever, malaria, pneumonia, community health worker, drug shop, chil
Assessment of partogram use during labour in Rujumbura Health Sub District, Rukungiri District, Uganda
No full textBackground: A partogram is a universal tool for monitoring labour. It
is used for labour management in Rujumbura HSD, Rukungiri District.
However, the District Health Officer reported only 30% use of a
partogram. The study intended to find out why the low use, and suggest
strategies in scaling up. Objectives: To establish extent of use of a
partogram, health facility and health workers' factors that affected
its use during labour plus the relationship between foetal Apgar score
and its use. Materials and Methods: A cross-sectional study involving
observations, record reviews and interviewing of staff in 8 health
facilities (4 Public and 4 Private Not For Profit) in Rujumbura HSD in
Rukungiri district was conducted from May 23rd to 27th June 2008. It
employed both qualitative and quantitative methods of data collection.
Results: The partogram was used in 69.9% of deliveries. The
partographs that fulfilled the standard monitoring of foetal heart rate
were only 2%. There were few trained health workers and lack of
guidelines on partogram use. A good Apgar score was associated with
standard foetal monitoring and was statistically significant (P <
0.001). Conclusions and recommendations: There was poor use of
partograms during labour mainly affected by health input factors. We
recommended training of health workers on partogram use, provision of
guidelines and adequate resources
Assessment of partogram use during labour in Rujumbura Health Sub District, Rukungiri District, Uganda
No full textBackground: A partogram is a universal tool for monitoring labour. It
is used for labour management in Rujumbura HSD, Rukungiri District.
However, the District Health Officer reported only 30% use of a
partogram. The study intended to find out why the low use, and suggest
strategies in scaling up. Objectives: To establish extent of use of a
partogram, health facility and health workers' factors that affected
its use during labour plus the relationship between foetal Apgar score
and its use. Materials and Methods: A cross-sectional study involving
observations, record reviews and interviewing of staff in 8 health
facilities (4 Public and 4 Private Not For Profit) in Rujumbura HSD in
Rukungiri district was conducted from May 23rd to 27th June 2008. It
employed both qualitative and quantitative methods of data collection.
Results: The partogram was used in 69.9% of deliveries. The
partographs that fulfilled the standard monitoring of foetal heart rate
were only 2%. There were few trained health workers and lack of
guidelines on partogram use. A good Apgar score was associated with
standard foetal monitoring and was statistically significant (P <
0.001). Conclusions and recommendations: There was poor use of
partograms during labour mainly affected by health input factors. We
recommended training of health workers on partogram use, provision of
guidelines and adequate resources
Clinical presentation of newly diagnosed diabetes patients in a rural district hospital in Eastern Uganda
Get PDFBackground: Our objective was to describe the clinical presentation of new diabetes patients in a rural hospital, to enhance clinical detection in low resource settings.Methods: A case series assessment of 103 new diabetes patients consecutively enrolled at Iganga Hospital in rural Eastern Uganda was conducted. All underwent a basic clinical assessment through the clinic’s routine procedures.Following diagnosis, variables pertinent to the study (symptoms, blood pressure, anthropometry, and blood glucose) were secondarily abstracted from their clinical records. Results: Fiftty two percent of new diabetes patients were female. The mean age was 49 years (SD=14.4). Two clinical symptoms were present in almost all new patients: Frequent urination (100%) and frequent thirst (79%). Moderately occurring symptoms (i.e. 25-50% of patients) included blurred vision, frequent eating and frequent sweating. The mean duration of symptoms was 1.4 years; 48% had high blood pressure while 46% were overweight. Random blood sugar was normal for 25% of patients. The majority (71%) were classified as having ‘moderate illness’ at diagnosis. Severe illness was significantly lower among patients aged 40 or older compared to younger patients (OR 0.1; 95% CI 0.03-0.35). Conclusion: Out-patients aged 40-65 years should be prioritised for early diabetes diagnosis and associated risk factors in this setting.Keywords: Diabetes, clinical presentation, newly diagnosed, unrecognized disease
Preventing Chronic Disease (PCD)
Get PDFIntroductionHypertension is a growing burden in Uganda and other low- and middle-income countries. Appropriate diagnosis services are needed at primary care health facilities to identify, initiate treatment for, and manage hypertension. This study assessed service availability and readiness as well as facilitators and barriers in primary health care facilities for hypertension diagnosis services in Wakiso District, Uganda.MethodsIn July and August 2019, we conducted structured interviews at 77 randomly selected primary care health facilities in Wakiso District. We used an interviewer-administered health facility checklist modified from the World Health Organization\u2019s service availability and readiness assessment tool. We also conducted 13 key informant interviews with health workers and district-level managers. Readiness was measured by availability of functional diagnostic equipment, related supplies and tools, and health provider attributes. Service availability was measured by assessing hypertension diagnosis services.ResultsMost (86%; 66 of 77) health facilities offered hypertension diagnosis services and 84% (65 of 77) had digital blood pressure measuring devices; only 69% (53 of 77) had functional blood pressure measuring devices. Lower-level facilities lacked appropriate blood pressure cuffs for use across age groups: 92% (71 of 77) lacked pediatric cuffs and 52% (40 of 77) lacked alternative adult cu\ufb00s. Facilitators for diagnosing hypertension included partners that built health facility staff capacity and funds for purchasing hypertension diagnostic supplies; common barriers were nonfunctional equipment, delays in receiving training, and inadequate staffing.ConclusionThe results highlight the need for an adequate supply of devices, routine replacements or repairs, and frequent refresher training for health workers.MC_UU_00033/3/MRC_/Medical Research CouncilUnited Kingdom
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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