Publications by authors named "Steven Kabwama"
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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- - This study investigates COVID-19 vaccine uptake among Nigerian adults across the six geopolitical zones, highlighting the low vaccination rates especially in the Northern regions, where 65.5% of respondents hadn't received the vaccine.
- - Utilizing a cross-sectional survey of 1,148 adults, the research identifies factors influencing vaccine acceptance, such as age, sex, occupation, and region, showing that about half of the participants had not been vaccinated, while 70% of unvaccinated individuals expressed intentions to receive the vaccine.
- - The study emphasizes the need for targeted public health strategies to improve vaccine uptake in Nigeria, considering the country’s diverse cultural and demographic landscape.
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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- Tuberculosis (TB) is a leading cause of death among people living with HIV (PLHIV), and TB preventive treatment (TPT) can significantly reduce the risk of developing active TB.
- During a study in Uganda from 2019-2021, 12% of PLHIV who started TPT were lost to follow-up, prompting an investigation into the factors contributing to this issue across four regional referral hospitals.
- Key findings revealed that younger adults (ages 20-29) and those who had been on antiretroviral therapy (ART) for less than three months were more likely to drop out of the TPT program, highlighting the need for targeted support for these groups to improve treatment adherence.
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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- Uganda's Ministry of Health introduced point-of-care HIV testing for early infant diagnosis (EID) to improve the speed of test result returns and access to antiretroviral therapy (ART) for HIV-exposed infants (HEI).* -
- The study analyzed EID data from 10 health facilities, comparing the time to sample collection, results receipt, and ART initiation before and after the rollout of point-of-care testing from 2018 to 2021.* -
- Results showed significant improvements in turnaround times for receiving results and starting ART, with 33% of HIV-positive infants starting treatment on the same day during point-of-care testing compared to only 4% before.*
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.
Introduction: Although the use of illicit drugs is common among young people, limited data exists on the use of illicit drugs among adolescent boys and young men (ABYM). We assessed the use of tobacco, marijuana and khat among ABYM to inform the design of harm-reduction interventions.
Methods: This secondary analysis uses data from a formative study conducted among 2,500 ABYM across the five divisions of Kampala between July and August 2020.
Article Synopsis
- Evidence from Ghana shows that non-pharmaceutical interventions like lockdowns during COVID-19 led to a significant decrease in the use of essential health services, prompting an investigation into challenges and strategies that emerged during this period.
- The study involved 34 participants, including healthcare providers and policy-makers, who highlighted that disruptions affected vital services such as maternal and child health, as well as treatment for various diseases, primarily due to barriers like fear, inadequate care quality, and financial constraints.
- To address these disruptions, a range of interventions were implemented at different levels, including community outreach, training health workers, and introducing policy changes, which collectively helped maintain essential health services throughout the pandemic in Ghana.
Background: Health systems are resilient if they absorb, adapt, and transform in response to shocks. Although absorptive and adaptive capacities have been demonstrated during the COVID-19 response, little has been documented about their transformability and strengthened service delivery systems. We aimed to describe improvements in maternal and child health service delivery as a result of investments during the COVID-19 response.
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- - HIV infection negatively impacts maternal health, leading to higher risks of death and complications during childbirth, with the study showing an increased maternal mortality ratio (MMR) for HIV-positive women compared to those who are HIV-negative.
- - The "Saving Mothers, Giving Life" initiative managed to lower maternal and neonatal mortality rates in Uganda during its implementation, with data from 116,066 births revealing that while HIV-positive women experienced more severe risks, antiretroviral drug (ARV) use significantly improved outcomes.
- - Non-use of ARVs among HIV-positive women drastically raised the chances of maternal and perinatal death, highlighting the importance of antiretroviral treatment in improving health outcomes for mothers and their infants.
Article Synopsis
- * The research involved analyzing historical data from the National TB and Leprosy Programme, mapping the spatial distribution of TB cases across different regions and districts within Uganda, revealing that the CNR varies significantly by area and time.
- * Findings indicate that certain districts like Moroto and Kampala consistently reported high CNR while others like Kalangala fluctuated, leading to recommendations for intensified efforts and increased funding for Uganda's National TB program.
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.
Background: The COVID-19 pandemic has led to substantial interruptions in critical health services, with 90% of countries reporting interruptions in routine vaccinations, maternal health care and chronic disease management. The use of non-pharmaceutical interventions (NPIs) such as lockdowns and self-isolation had implications on the provision of essential health services (EHS). We investigated exemplary COVID-19 outbreak control strategies and explored the extent to which the adoption of these NPIs affected the provision of EHS including immunization coverage and facility-based deliveries.
View Article and Find Full Text PDFWe implemented and assessed a comprehensive, antenatal care (ANC)-embedded strategy to prevent HIV seroconversions during pregnancy in Uganda. HIV-negative first-time ANC clients were administered an HIV risk assessment tool and received individual risk counseling. Those attending ANC without partners obtained formal partner invitation letters.
View Article and Find Full Text PDFRegional differences in the utilisation of antenatal care and skilled birth attendant services during the COVID-19 pandemic in Nigeria: an interrupted time series analysis.
BMJ Glob Health
October 2023
Introduction: The COVID-19 pandemic has had a substantial negative impact on the utilisation of essential health services (EHS) globally, especially in resource-limited settings such as Nigeria. High maternal deaths associated with low access to and utilisation of EHS such as antenatal care (ANC) and skilled birth attendants (SBAs) remain a concern during the COVID-19 era. The study assessed the COVID-19 pandemic effects on ANC and SBA utilisation across regions in Nigeria.
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- 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.
Article Synopsis
- * 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.
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.
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.
Background: The COVID-19 pandemic has impacted the world negatively with huge health and socioeconomic consequences. This study estimated the seasonality, trajectory, and projection of COVID-19 cases to understand the dynamics of the disease spread and inform response interventions.
Method: Descriptive analysis of daily confirmed COVID-19 cases from January 2020 to 12 March 2022 was conducted in four purposefully selected sub-Saharan African countries (Nigeria, Democratic Republic of Congo (DRC), Senegal, and Uganda).
In April 2019, the District Health Office of Oyam District, Uganda reported an upsurge in malaria cases exceeding expected epidemic thresholds, requiring outbreak response. We investigated the scope of outbreak and identified exposures for transmission to inform control measures. A confirmed case was a positive malaria rapid diagnostic test or malaria microscopy from 1 January-30 June 2019 in a resident or visitor of Acaba Sub-county, Oyam District.
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- Communicable diseases, particularly tuberculosis (TB) and HIV/AIDS, are major health issues in refugee settings, contributing significantly to morbidity and mortality during complex emergencies.
- A study was conducted on TB treatment outcomes among 254 patients at two healthcare facilities in Kyangwali Refugee Settlement, revealing that 55% of patients had favorable outcomes while 45% had unfavorable ones.
- Factors such as increasing age were linked to unfavorable outcomes, and those diagnosed with multidrug-resistant TB (MDR-TB) had better odds of achieving favorable treatment outcomes, although overall treatment success rates were lower than the World Health Organization's recommended 85%.
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.
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.