Browsing by Author "Twineamatsiko, Andrew"

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    Exploring barriers and facilitators of preceptorship in undergraduate health professions education : insights from a qualitative needs assessment among preceptors in Eastern Uganda.
    (BMC, 2025) Wani, Solomon; Nantale, Ritah; Atuhairwe, Irene; Makoko, Brian Tonny; Okello, Francis; Waako, Paul; Twineamatsiko, Andrew; Agaba, Brian; Nyalihama, Alain; Kibuule, Dan; Kagoya, Enid Kawala
    Background: Clinical preceptorship plays a critical role in bridging theoretical knowledge and practical skills for health professions students. In resource-constrained settings like Eastern Uganda, understanding what facilitates effective preceptorship is essential for improving clinical education outcomes. This study explores the barriers and facilitators to preceptorship among clinical preceptors and faculty at Busitema University, Mbale College of Health Sciences, and Mbale Regional Referral Hospital. Methods: We conducted 15 in-depth interviews with clinical preceptors, including faculty and clinical staff from Busitema University, Mbale College of Health Sciences, and Mbale Regional Referral Hospital. Participants were purposively selected based on experience, education level, medical care, and leadership roles. We conducted the interviews between May 2024 and June 2024, audio-recorded, were transcribed verbatim, and thematically analyzed using Atlas.ti version 9. Results: Three key facilitators and six barriers to preceptorship emerged from the analysis. The facilitators included: support from Seed Global Health through donations of medical tools, equipment, and healthcare worker training; strong commitment and willingness among health workers at Mbale Regional Referral Hospital to teach students; and, support from faculty and postgraduate students at Busitema University. Barriers were: high numbers of students in clinical settings; poor communication and coordination between academic institutions and clinical sites; limited preceptorship skills and knowledge among clinical preceptors; shortages of faculty preceptors; insufficient time for clinical rotations; and inadequate models and equipment for simulation-based teaching. To address these challenges, preceptors recommended better coordination and student orientation, phased placement in smaller groups, training and refresher courses to strengthen preceptorship capacity, increased faculty presence in wards, and provision of essential medical equipment. Conclusion: Effective preceptorship in resource-limited settings depends on leveraging facilitators while addressing persistent barriers. External partnerships, staff commitment, and faculty support are valuable enablers, but their impact is undermined by overcrowding, poor coordination, and resource shortages. Actionable strategies such as structured communication between training institutions and hospitals, phased student placement, targeted preceptor training, and investments in teaching equipment can mitigate barriers and reinforce facilitators. Strengthening these systems is vital for sustaining high-quality clinical education in Uganda and similar contexts. Keywords: Preceptorship, Barriers, Facilitators, Medical education, Uganda
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    Factors associated with longer hospital stay following caesarean section birth at a tertiary hospital in Eastern Uganda.
    (Research Square, 2025) Thaddeus, Jude Mulowooza; Tweheyo, Ronald; Babuya, Jonathan; Atuhairwe, Irene; Makoko, Brian Tonny; Waako, Paul; Twineamatsiko, Andrew; Agaba, Brian; Stephen, Obbo; Kavuma, Pontian Kiwanuka; Kibuule, Dan; Kayemba, Frank; Kagoya, Enid Kawala
    Background. Caesarean Section(C/S) is a lifesaving procedure for both the mother and the baby but it is associated with various post-operative complications and longer hospital stays. Prolonged Hospitalization after a Caesarean section can be stressful for both the healthcare providers and the mothers while also risking them acquiring hospital acquired infections. Factors related to longer hospital stays among mothers delivered by C/S have not been well explored. This study aimed to determine the factors associated with longer (> 4 days) hospital stay following Caesarean birth at Mbale Regional Referral Hospital. Methods This was a retrospective cross-sectional study carried out at Mbale Regional Referral Hospital (MRRH) between December 2023 and May 2024 accessed in June 2024. A total of 536 patient files of women who underwent Caesarean section were randomly selected and reviewed. Data on social demographics, obstetric characteristics and other surgical details including outcomes was extracted and recorded using an online data collection tool. Descriptive analysis to summarise the data and logistic regression to identify factors associated with longer hospital stays were done, and P-values < 0.05 significance level at a 95% confidence interval were considered. Results The mean hospital stay was 4.02 days (SD ± 2.87). Nearly half of the women (47.6%) were referred from other health facilities with most caesarean sections (70.9%) sanctioned by junior house officers. Preoperative prophylactic antibiotics were administered in 85.4% and spinal anaesthesia was used in 98.5% of the Csections. In multivariable analysis, lack of a complete blood count, vaginal preparation, intravenous fluids before surgery and a patient undergoing general anesthesia were significantly related to longer hospital stays. Conclusion Multiple factors are associated with longer hospital stays at Mbale Regional Referral Hospital. Improvement of evidence-based practices such as the intravenous fluids, vaginal preparation and basic laboratory investigations before surgery and use of spinal anesthesia can help to reduce hospital stay and its associated risks. Keywords: Caesarean section, longer hospital stay, postoperative complications
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    ‘They treat you like their own’ perspectives and lived experiences of postpartum women seeking health services from traditional birth attendants (TBAs) in Mayuge district east central Uganda.
    (Research Square, 2025) Kagoya, Enid Kawala; Auma, Proscovia; Mugabi, Joshua; Kawala, Elizabeth; Asabawebwa, Deogratias; Mugahi, Richard; Mutunda, Brenda Doreen; Twineamatsiko, Andrew; Kabene, Mercy Jackline; Frank, Kayemba; Waako, Paul; Mugabe, Kenneth; Akello, Jackline
    Background In Uganda, despite ongoing efforts to promote skilled birth attendance, many women in rural communities continue to deliver with Traditional Birth Attendants (TBAs). Understanding the reasons behind this preference and the nature of care provided by TBAs is critical for informing maternal health policy and community-level interventions. Objective To explore the experiences, perceptions, and underlying factors influencing the continued use of TBAs for childbirth among postpartum women in Mayuge District, Eastern Uganda. Methods A descriptive qualitative study was conducted in Mayuge District. In-depth interviews were held with 12 postpartum women who had delivered with TBAs within the past six months. Participants were purposively selected to capture variation in age, parity, and location. Data were collected using a semi structured interview guide, audio-recorded, transcribed verbatim, and translated into English. Thematic analysis was conducted using both inductive and deductive coding in NVivo 13. Results Five overarching themes emerged: (1) Health System Barriers, including poor access to health facilities, transport challenges, and mistreatment by health workers; (2) Perceived Benefits of TBA Care, such as affordability, emotional support, privacy, and flexible payment options; (3) Traditional Practices and Beliefs, with participants emphasizing cultural alignment, spiritual care, and birth rituals provided by TBAs; (4) Health Risks and Limits of TBA Care, reflecting awareness of complications, delayed referrals, and lack of emergency support; and (5) Community Influence, where social norms, peer recommendations, and collective trust in TBAs shaped decision-making. A cross-cutting theme of husband and family involvement also significantly influenced birth location choices. Conclusion The continued reliance on TBAs is shaped by a complex interplay of structural barriers, cultural values, perceived advantages, and community dynamics. Interventions to improve maternal health in rural Uganda should address health system gaps, promote respectful and culturally sensitive facility-based care, and engage families and communities in birth preparedness efforts. Keywords: Traditional Birth Attendants, Postpartum Women, Maternal Health, Uganda, Qualitative Study, Health-Seeking Behavior, Cultural Beliefs, Health System Barriers, Community Influence.