Publications by authors named "Kiwanuka S"

Background: The Coronavirus disease (COVID-19) pandemic caused significant morbidity and mortality in Africa, in addition to other socio-economic consequences. Across the continent, Schools of Public Health (SPHs) played several roles in supporting national, regional, and global response to the pandemic. Following a published and grey literature search, this paper reviews and analyses the contribution of SPHs in Africa during the COVID-19 pandemic.

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Background: Vaccine responses differ between populations and are often impaired in rural and low-income settings. The reasons for this are not fully understood, but observational data suggest that the immunomodulating effects of parasitic helminths might contribute. We hypothesised that Schistosoma mansoni infection suppresses responses to unrelated vaccines, and that suppression could be reversed-at least in part-by intensive praziquantel administration.

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Background: The Corona Virus Disease 2019 (COVID-19) pandemic overwhelmed health systems and disrupted the delivery of health services globally. Community Health Workers (CHWs) play a critical role in linking communities to health systems, supporting the prevention and control of diseases in many low- and middle-income countries. However, their roles, barriers, and facilitators in the response and control of the COVID-19 pandemic have not been well documented.

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Introduction: Each person having access to needed health services, of sufficient quality, and without suffering financial hardship, defined as universal health coverage (UHC) by the World Health Organization, is critical to improve population health, particularly for vulnerable populations. UHC requires multisectoral collaboration and good governance, and this will require buy-in of key stakeholders; but their views are under-documented. The aim of this stakeholder analysis was to explore the awareness and perceptions of UHC by health care workers (HCWs) in Uganda.

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Article Synopsis
  • The study investigates sex differences in COVID-19 vaccine uptake and intention to vaccinate across four African countries: DRC, Nigeria, Senegal, and Uganda, using data from mobile surveys conducted from March to June 2022.!
  • Findings show that while self-reported vaccination rates were similar between males and females, males had a significantly higher intention to vaccinate, influenced by factors like trust in health authorities and their residence type.!
  • Trust in government institutions and the perceived truthfulness of information were crucial in determining vaccine uptake and intentions for both sexes, highlighting the importance of these factors in designing effective vaccination campaigns.
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Background: Malnutrition remains a health challenge for women aged 15 to 49 years and their infants. While Nutrition Assessment Counselling and Support (NACS) is considered a promising strategy, evidence of its effectiveness remains scanty. This study assessed the effect of the comprehensive NACS package on the mother-infant practices, health and nutrition outcomes in two districts in Eastern Uganda.

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Article Synopsis
  • The COVID-19 pandemic greatly challenged the health workforce globally, highlighting the need for motivated health workers to maintain effective service delivery, particularly in countries like DRC, Senegal, Nigeria, and Uganda.
  • A qualitative study involving 60 key informant interviews explored the incentives and dis-incentives faced by health workers during the pandemic response in these countries, utilizing virtual methods for data collection.
  • Results indicated that financial rewards and a variety of non-financial support, including medical care and recognition, significantly motivated health workers, while dis-incentives such as insufficient protective equipment and long working hours posed serious challenges.
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Background: Equity is at the core and a fundamental principle of achieving the family planning (FP) 2030 Agenda. However, the conceptualization, definition, and measurement of equity remain inconsistent and unclear in many FP programs and policies. This paper aims to document the conceptualization, dimensions and implementation constraints of equity in FP policies and programs in Uganda.

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Background: While priority setting is recognized as critical for promoting accountability and transparency in health system planning, its role in supporting rational, equitable and fair pandemic planning and responses is less well understood. This study aims to describe how priority setting was used to support planning in the initial stage of the pandemic response in a subset of countries in the Western Pacific Region (WPR).

Methods: We purposively sampled a subset of countries from WPR and undertook a critical document review of the initial national COVID-19 pandemic response plans.

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Background: Health planning and priority setting with a gender lens can help to anticipate and mitigate vulnerabilities that women and girls may experience in health systems, which is especially relevant during health emergencies. This study examined how gender considerations were accounted for in COVID-19 pandemic response planning in a subset of countries in Africa.

Methods: Multi-country document review of national pandemic response plans (published before July 2020 and as of March 2022) from Ethiopia, Ghana, Kenya, Nigeria, Rwanda, South Africa, Uganda, and Zambia, supplemented with secondary data on gender representation on planning committees.

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In many countries in Africa, there is a 'paradoxical surplus' of under and unemployed nurses, midwives, doctors and pharmacists which exists amidst a shortage of staff within the formal health system. By 2030, the World Health Organisation Africa Region may find itself with a shortage of 6.1 million health workers alongside 700,000 un- or underemployed health staff.

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Background: Uganda embraced Nutrition Assessment Counselling and Support (NACS) since 2009 as a health system strengthening approach to improve health and nutrition outcomes. However, scant evidence exists on NACS integration and drivers. This study therefore assessed the extent of NACS integration in the health system and identified key drivers and barriers.

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Background: African countries leveraged testing capacities to enhance public health action in response to the COVID-19 pandemic. This paper describes experiences and lessons learned during the improvement of testing capacity throughout the COVID-19 response in Senegal, Uganda, Nigeria, and the Democratic Republic of the Congo (DRC).

Methods: The four countries' testing strategies were studied using a mixed-methods approach.

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Article Synopsis
  • Governments worldwide closed schools during the COVID-19 pandemic to limit transmission, impacting four sub-Saharan African countries: DRC, Nigeria, Senegal, and Uganda.
  • A qualitative study involving key informants revealed both desirable outcomes (like increased use of online learning) and undesirable outcomes (such as increased sexual violence and inadequate educational continuity).
  • The overall impact of these school closures has been largely negative, with both immediate and long-term consequences for students and the educational system as a whole.
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  • * A study analyzed the use of digital technology in Uganda during the pandemic, identifying its applications in testing, contact tracing, risk communication, and health service maintenance, as well as challenges like poor data quality and infrastructure.
  • * Key barriers included disparate digital tools leading to inefficiencies, limited accessibility, and inadequate technology support, highlighting the need for improved technology adoption, equity, and infrastructure for future public health emergencies.
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Evidence should be the foundation for a well-designed family planning (FP) program, but existing evidence is rarely aligned with and/or synthesized to speak directly to FP programmatic needs. Based on our experience cocreating FP research and learning agendas (FP RLAs) in Côte d'Ivoire, Malawi, Mozambique, Nepal, Niger, and Uganda, we argue that FP RLAs can drive the production of coordinated research that aligns with national priorities.To cocreate FP RLAs, stakeholders across 6 countries conducted desk reviews of 349 documents and 106 key informant interviews, organized consultation meetings in each country to prioritize evidence gaps and generate research and learning questions, and, ultimately, formed 6 FP RLAs comprising 190 unique questions.

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Background: Cervical cancer is a major public health challenge, accounting for substantial morbidity and mortality. Human Papilloma Virus (HPV) vaccination is the recommended primary public health intervention for HPV infection prevention. However, there's limited evidence on the level of knowledge, attitude, and practices of adolescent girls regarding HPV vaccination in Kampala city, Uganda.

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Article Synopsis
  • - The COVID-19 pandemic prompted non-pharmaceutical interventions (NPIs) in four African countries, including lockdowns and travel restrictions, which had both positive and negative unintended consequences across economic, psychosocial, and environmental aspects.
  • - A mixed-methods study was conducted in the Democratic Republic of Congo, Nigeria, Senegal, and Uganda, using literature reviews, secondary data analysis, and key informant interviews to identify these consequences.
  • - Positive outcomes included reduced crime rates and improved hygiene practices, while negative effects encompassed economic downturns, job losses, increased domestic violence, mental health issues, and greater waste generation.
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Introduction: As part of efforts to rapidly identify and care for individuals with COVID-19, trace and quarantine contacts, and monitor disease trends over time, most African countries implemented interventions to strengthen their existing disease surveillance systems. This research describes the strengths, weaknesses and lessons learnt from the COVID-19 surveillance strategies implemented in four African countries to inform the enhancement of surveillance systems for future epidemics on the continent.

Methods: The four countries namely the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda, were selected based on their variability in COVID-19 response and representation of Francophone and Anglophone countries.

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Article Synopsis
  • The study focused on the uptake of COVID-19 vaccines among adults in Uganda, highlighting that 49.7% of participants were vaccinated, with intentions for future vaccination high among the unvaccinated (91%).
  • Key reasons for vaccination included personal protection from COVID-19, while non-uptake was primarily due to vaccine availability issues and concerns about safety and effectiveness.
  • Factors influencing vaccine uptake included older age, higher education levels, medium-income status, and reliance on health workers for information, with recommendations for improving vaccine access and utilizing health workers to boost vaccination rates.
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Background: Coronavirus disease 2019 (COVID-19) altered healthcare utilization patterns. However, there is a dearth of literature comparing methods for quantifying the extent to which the pandemic disrupted healthcare service provision in sub-Saharan African countries.

Objective: To compare interrupted time series analysis using Prophet and Poisson regression models in evaluating the impact of COVID-19 on essential health services.

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Introduction: The COVID-19 pandemic overwhelmed health systems globally and affected the delivery of health services. We conducted a study in Uganda to describe the interventions adopted to maintain the delivery of other health services.

Methods: We reviewed documents and interviewed 21 key informants.

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Background: In May 2018, following the preliminary results of a study in Botswana that reported congenital anomalies in babies born to HIV-positive women taking dolutegravir drug, the WHO issued a teratogenicity alert. However, there are scarce data on the impact of this guidance on contraceptive uptake among women taking dolutegravir. We assessed the uptake of contraceptives in HIV-positive women of reproductive age on dolutegravir regimens.

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Background: Private entities play a major role in health globally. However, their contribution has not been fully optimized to strengthen delivery of public health services. The COVID-19 pandemic has overwhelmed health systems and precipitated coalitions between public and private sectors to address critical gaps in the response.

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Background: Understanding of the most economical and sustainable models of providing geriatric care to Africa's rising ageing population is critical. In Uganda, the number of old adults (60 years and above) continues to rise against absence of policies and guidelines, and models for providing care to this critical population. Our study explored public primary health care provider views on how best community-based geriatric support (CBGS) could be instituted as an adaptable model for delivering geriatric care in Uganda's resource-limited primary public health care settings.

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