Catherine Kansiime

Knowledge and perceptions of brucellosis in the pastoral communities adjacent to Lake Mburo National Park, Uganda

BackgroundBrucellosis is one of the most common zoonotic infections globally. Lack of knowledge about brucellosis may affect the health-seeking behavior of patients, thus leading to sustained transmission in these communities. Our study assessed knowledge and perceptions of brucellosis among pastoral communities adjacent to Lake Mburo National Park (LMNP), Kiruhura District, Uganda.MethodsA community cross-sectional questionnaire survey involving 371 randomly selected household heads from three sub-counties neighboring LMNP were interviewed between June and August 2012. Data collected included communities’ knowledge on causes, symptoms, transmission, treatment, prevention and risk factors of brucellosis. Multivariable logistic regression analysis was performed to explore strength of association between overall knowledge of brucellosis and various individual factors using odds ratios and 95% confidence intervals.ResultsOnly 70 (19%) knew the symptoms of brucellosis in animals, and three quarters (279, 75.5%) mentioned joint and muscle pain as a common symptom in humans. Almost all participants (370, 99.3%) had ever heard about brucellosis, majority (311, 84.7%) believed it affects all sexes and two thirds (67.7%) of the respondents believed close proximity to wildlife contributes to the presence of the disease. Almost all (352, 95.4%) knew that brucellosis in humans could be treatable using modern drugs. The main routes of infection in humans such as consumption of unpasteurized dairy products were known by 97% (360/371); eating of half-cooked meat by 91.4% and eating contaminated pasture in animals by 97.4%. There was moderate overall knowledge of brucellosis 197 (53.1%). Factors associated with higher overall knowledge were being agro-pastoralists (aOR: 2.08, CI: 1.17-3.71) compared to pure pastoralists while those who reported that the disease was a health problem (aOR: 0.18, CI: 0.06-0.56) compared to those who said it was not were less likely to be knowledgeable.ConclusionsThere was moderate overall knowledge of human and animal brucellosis among the participants. Majority of the participants believed that close proximity to wildlife contributes to the presence of the disease in the area. There is a need for collaboration between the public health, veterinary and wildlife sectors to provide health education on brucellosis for better management of the disease in the communities.

Health service delay among pulmonary tuberculosis patients presenting to a National Referral Hospital, Kampala, Uganda: a cross sectional study

Introduction Delay in the diagnosis of pulmonary tuberculosis (PTB) is common in many countries in Sub-Saharan Africa. Timely diagnosis of active tuberculosis is crucial in minimizing morbidity and mortality in the community as well as nosocomial transmission in health care facilities. This study aimed at determining factors associated with health service delay in the diagnosis and initiation of treatment among new PTB patients presenting to the National Referral Hospital-Mulago. Methods This was a cross-sectional study among eligible new PTB patients presenting at the National referral TB treatment center Mulago hospital, between March to May 2009. The patients were consecutively recruited and interviewed using a semi-structured questionnaire to assess socio- demographic and health service factors. Multivariate logistic regression using odds ratios and 95% confidence intervals was done. Results Two hundred and sixty six newly diagnosed PTB patients were enrolled, of which 65.4% experienced health systems delay. The median health service delay was 9days (IQR=8-19). Factors associated with health service delay were: 1n-patient (OR= 4.68, 95% CI: 1.91-11.45), secondary as highest level of education attained (OR= 3.56, 95% CI: 1.18-10.74), primary as highest level of education attained (OR= 6.70, 95% CI: 2.13-21.02), presence of fever (OR= 3.28, 95% CI: 1.05-10.79), and patient delay at health facility (OR= 5.01, 95% CI: 1.33-18.9). Conclusion The study found a significant proportion of Health service delay among pulmonary tuberculosis patients presenting at the referral hospital. Being an in-patient and having fever as a symptom of tuberculosis needs further attention in order to have timely diagnosis. There is need for awareness on TB especially that most of the TB symptoms present like other febrile illnesses such as malaria and needs consideration when patients present to a health facility.

Determinants of Patients' Choice of Provider in Accessing Brucellosis Care among Pastoral Communities Adjacent to Lake Mburo National Park in Kiruhura District, Uganda

Background Brucellosis is the commonest zoonotic infection worldwide with symptoms similar to other febrile syndromes such as malaria and typhoid fever. It is often easily misdiagnosed, resulting in underreporting and misdirected treatments. Understanding of the factors that influence brucellosis care seeking is essential in enhancing its effective management. Our study sought to determine the factors associated with choice of provider in accessing care for brucellosis among pastoral communities in Uganda. Methods This was a cross-sectional survey involving 245 randomly selected respondents previously diagnosed and treated for brucellosis, two months before the study. They were enrolled from three sub-counties neighboring Lake Mburo National Park between December 2012 to April 2013. Data on socio-demographics, availability, accessibility, affordability and acceptability of health services were collected. A multivariable logistic regression model was fitted to determine association between independent and outcome variables using odds ratios and 95% confidence intervals with p-value≤0.05 considered statistically significant. Results Of the 245 respondents, 127(51.8%) sought health care at government facilities and the rest at private. Respondents who were less likely to choose a government facility were either single (OR: 0.50, CI: 0.26–0.97), had general weakness (OR: 0.09, CI: 0.01–0.72) or whom family took a decision (OR: 0.52, CI: 0.28–0.97). At multivariable analysis, choice of government facility was influenced by primary education (aOR: 0.46, CI: 0.22–0.97), having six to ten household members (aOR:3.71, CI:1.84–7.49), family advice (aOR:0.64, CI: 0.23–0.91), distance ≥10 kms (aOR:0.44, CI: 0.21–0.92), high costs at private clinics (aOR:0.01, CI:0.02–0.15) and no diagnosis at government facility (aOR:0.11, CI:0.01–0.97). Females were more likely to seek health care at government facilities, while those with tertiary education were less likely, after the first provider. Conclusions Females and households with six to ten members were more likely to choose government facilities. Government facilities need to be equipped to attract more patients.

Multidrug resistance among Escherichia coli and Klebsiella pneumoniae carried in the gut of out-patients from pastoralist communities of Kasese district, Uganda

Background Antimicrobial resistance is a worldwide public health emergency that requires urgent attention. Most of the effort to prevent this coming catastrophe is occurring in high income countries and we do not know the extent of the problem in low and middle-income countries, largely because of low laboratory capacity coupled with lack of effective surveillance systems. We aimed at establishing the magnitude of antimicrobial resistance among Escherichia coli and Klebsiella pneumoniae carried in the gut of out-patients from pastoralist communities of rural Western Uganda. Methods A cross-sectional study was carried out among pastoralists living in and around the Queen Elizabeth Protected Area (QEPA). Stool samples were collected from individuals from pastoralist communities who presented to the health facilities with fever and/or diarrhea without malaria and delivered to the microbiology laboratory of College of Health Sciences-Makerere University for processing, culture and drug susceptibility testing. Results A total of 300 participants fulfilling the inclusion criteria were recruited into the study. Three hundred stool samples were collected, with 209 yielding organisms of interest. Out of 209 stool samples that were positive, 181 (89%) grew E. coli, 23 (11%) grew K. pneumoniae and five grew Shigella. Generally, high antibiotic resistance patterns were detected among E. coli and K. pneumoniae isolated. High resistance against cotrimoxazole 74%, ampicillin 67%, amoxicillin/clavulanate 37%, and ciprofloxacin 31% was observed among the E. coli. In K. pneumoniae, cotrimoxazole 68% and amoxicillin/clavulanate 46%, were the most resisted antimicrobials. Additionally, 57% and 82% of the E. coli and K. pneumoniae respectively were resistant to at least three classes of the antimicrobials tested. Resistance to carbapenems was not detected among K. pneumoniae and only 0.6% of the E. coli were resistant to carbapenems. Isolates producing ESBLs comprised 12% and 23% of E. coli and K. pneumoniae respectively. Conclusion We demonstrated high antimicrobial resistance, including multidrug resistance, among E. coli and K. pneumoniae isolates from pastoralist out-patients. We recommend a One Health approach to establish the sources and drivers of this problem to inform public health.

Health Care Worker’s Experience on Rapid Diagnostic Test (Rdt) for Malaria and Their Views on Community Acceptability of Rdt in Rubavu District, Rwanda: Qualitative Study

Background: Malaria remains one of the major public health problems in Rwanda. The country introduced artemisinin combination therapy (ACT) at community level using community health workers (CHWs) for treatment of uncomplicated malaria in 2008. Use of ACT with reliance on presumptive diagnosis may lead to excessive use, increased costs and rise of drug resistance. Thus to overcome these challenges, rapid diagnostic tests (RDTs) was introduced to be done by CHWs. This study assessed health care workers experience regarding RDT and their feelings on acceptability of RDTs by community members. Methods: This was a qualitative research approach conducted in five sectors of Rubavu District. Three focus group discussions (FGDs) among community health workers and five key informant interviews (KIIs) were conducted among three in-charges of CHWs, supervisor of the in-charges of CHWs and district health officer. Data were transcribed and coded and then analysed thematically. Results: The study found that CHWs were well experienced in using RDTs. Moreover, district community health supervisor and a district health director confirmed that CHWs were quite experienced in the services they provide. The study further indicated that community acceptability of RDTs for malaria testing was high from the views of health care workers compared to microscopy testing. Conclusion: The data indicated that community health workers are well experienced in the use of RDT for malaria diagnosis and the views of CHWs indicate high acceptability of RDTs for malaria by the community.

Factors Associated with Malaria Test Preference among Households in Rubavu District, Rwanda: A Cross-sectional Study

Background: If people are not diagnosed and treated promptly for malaria, they may develop severe complications and death. Globally, an estimated 3.3 billion people are at risk of being infected with malaria and 1.2 billion are at high risk. The World Health Organization recommends using malaria rapid diagnostic tests (RDTs) or microscopy followed by prescribing antimalarial only to patients who have a positive test result. In Rwanda, malaria RDT was introduced in 2008 to be used by community health workers (CHWs) before offering treatment. This study assessed malaria test preference and associated factors among community members in Rubavu district, Rwanda. Methods: This was a quantitative cross-sectional study. A structured self-administered questionnaire was given to 384 community members in households that were randomly pre-selected from community of Rubavu district. Chisquare test (p<0.05) was computed to establish factors associated with preference of malaria diagnostic test. Results: The result shows that majority (77.6%) of the respondents prefer RDT over microscopy test (22.4%). The RDT was more preferable among household heads with low level of education (never attended, primary school, and secondary school) (p=0.001), with low monthly income (p=0.002) and those with community based health insurance (p=001). Descriptive analysis was also done for perceived benefits of using RDTs, reasons for not accepting RDTs and suggestions to improve RDTs in the community, the results show that majority 96.9% perceived that RDTs is used as fast diagnosis, 84.9% not accept using RDTs because on non-trusted results and 90.6% suggested provision of pictorial job aid to the CHWs. Conclusion: Universal RDTs to all human species called combination or ‘combo’ test are the preferred method for the diagnosis of malaria by communities in Rubavu district. The test is more acceptable in households with low level of education, low monthly income, with community based health insurance.