Browsing by Author "Kabahinda, Nichola"

Now showing 1 - 2 of 2
  • No Thumbnail Available
    Item
    Health system readiness and diagnostic capacity for tuberculosis screening in primary health care facilities in Mbale city, eastern Uganda.
    (Busitema University, 2026) Kabahinda, Nichola
    Background: Tuberculosis (TB) continues to be one of the causes of morbidity and mortality in Uganda with an annual incidence of 196-200 new cases per 100,000 persons. While there have been commitments by the government and international community towards TB elimination, a significant gap exists in TB case detection which continues to hamper efforts to combat TB especially at the PHC level which is where initial contacts take place for TB patients. Health system readiness, which includes qualified staff, availability of diagnostic tests, supplies, and adequate supervision, is a key factor influencing TB screening and case detection. There has not been much research carried out in Eastern Uganda regarding TB screening readiness. Objectives: The current study was intended to evaluate the readiness of the health system and the diagnostic capability of primary health care facilities in Mbale city, Eastern Uganda to conduct TB screening. Specific objectives included: (i) To establish the availability of TB screening equipment, materials and instruments; (ii) To assess human resources and their competencies in conducting TB screening and diagnosing cases; and (iii) To evaluate the efficiency of the TB samples' referral services and the time taken for diagnosis. Methods: Cross-sectional study design using quantitative data collection technique was used among 11 public primary health care facilities within Mbale city that include Health Center II, III and IV level facilities. The study population consisted of two groups of participants including 69 health care workers involved in TB screening and 11 in-charges of various health centers. Questionnaires adapted from the SARA and Uganda NTLP readiness tools were used. A checklist tool was used to review health facility infrastructure, equipment, supply and documentation system. Results: TB screening registers were present in 68/69 (98.6%) of service delivery points, while all 11 facilities (100%) documented TB symptoms routinely, suggesting adequate administrative preparedness. However, there were major operational gaps identified across all three study domains. On the matter of infrastructure and supplies, specimen transport items were not available in 6/11 (54.5%) of facilities, and stock-outs of GeneXpert cartridges, microscopy reagents, and sputum cups were noted in many facilities over the previous six months. On the other hand, only 5/11 (45.5%) of the facilities offered on-site GeneXpert testing, while 52/69 (75.4%) referred specimens for molecular testing. In regard to human resource capacity, only 32/69 (46.4%) of the healthcare providers had undergone TB screening training within the previous 24 months, and just 52/68 (76.5%) correctly described the national TB screening algorithm. Routine TB symptom screening of all patients attending the OPD services was conducted by only 34/69 (49.3%) of the workers. Finally, on the issue of referral system functionality, the mean diagnostic turn-around time was 8.41 days (SD ±8.96; range 1–30 days), which is far above the two-day WHO recommended threshold. Treatment initiation delays following a positive result were reported by 21/69 (30.4%) of workers, most commonly attributed to resource limitations (7/19, 36.8%) and prolonged turnaround times (5/19, 26.3%). Conclusion: PHC centers within Mbale city are well equipped for documentation of tuberculosis screening processes yet exhibit several operational challenges such as weak supply chain management, low health worker training and ineffective referral services. Inability of the health care system to translate intentions into actions is demonstrated through extended periods of test turnaround time, inconsistent outpatient department screening practices and weak supply chain systems; thus, creating inefficiencies within the diagnostic process and causing pre-treatment dropouts. It is crucial for intervention measures including strengthening of the supply chain vi systems, provision of annual training for health workers, and rapid decentralization of GeneXpert testing centers to PHC III centers to be implemented.
  • No Thumbnail Available
    Item
    Watching over life : practices and meanings of postpartum vital signs monitoring in eastern Uganda.
    (medRxiv, 2025) Babuya, Jonathan; Kayemba, Frank; Waiswa, Sinani; Nsubuga, Allan G.; Ewing, Helen; Atuhairwe, Irene; Ijangolet, Esther; Otim, Eric; Ronald, Kibuuka; Jesca, Atugonza; Okello, Francis; Nakattudde, Prossy; Nyangoma, Faith; Nakawuka, Betty; Kabahinda, Nichola; Kamwesigye, Assen; Apoya, Jill; Waako, Paul; Wandabwa, Julius; Musaba, Milton; Bonaventure, Ahaisibwe; Aeby, Tod; Nandutu, Sarah; Mugabe, Kenneth; Pangholi, Kennedy; Nahurira, Doreck; Agaba, Brian; Mbwali, Immaculate; Bahati, Johnson; Kagoya, Enid Kawala
    Introduction Postnatal deaths account for about one-third of maternal mortality in Low- and middle-income countries (LMICs). Nearly half occur within the first 24 hours and are preventable through continuous inpatient monitoring. This study assessed maternal mortality within the first 24 postnatal hours; and the current postpartum monitoring practices, including the availability of monitoring charts and the frequency of vital sign assessments in eastern Uganda. Methods This cross-sectional study reviewed the medical records of all postpartum women admitted at Mbale Regional Referral Hospital, Eastern Uganda, between August 2022 and February 2023. A semi-structured data extraction form was used. The outcome variable was postpartum monitoring; categorized as "No" for women with no vital signs monitored and "Yes" for those with at least one vital sign monitored. Descriptive analysis was performed using Stata Version 17.0, and Poisson regression was employed to explore the association between various factors and postpartum monitoring. Results Medical records of 2,717 postpartum mothers were reviewed. The median (interquartile range) age was 25(20-30) years. A minority (34%; 910/2717) of mothers had vital sign observation charts in their medical records and very few (4%; 110/2717) had a fluid balance chart. About 49 24% (651/2717) of mothers had at least one vital sign recorded. Blood pressure was the most (16.8%; 456/2717) recorded vital sign followed by pulse rate (13.6%; 369/2717). Respiratory rate and temperature were the least monitored vital signs with 1.2% and 1.1% records respectively. Mothers who delivered by C-section had a 151% higher prevalence of postpartum monitoring compared to those who had a vaginal delivery (aPR: 2.51; 95% CI: 2.19–2.89). Maternal mortality rate on the first postpartum day was 8.8 per 1000, with postpartum hemorrhage accounting for 61%. Conclusion Postpartum vital signs monitoring was low. LMICs need to devise means of automating the monitoring process.