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Chanda P.,Ministry of Health Headquarters | Hamainza B.,Operational Research Unit | Moonga H.B.,Parasitology Unit | Chalwe V.,Tropical Diseases Research Center | Pagnoni F.,World Health Organization
Malaria Journal

Background: Access to prompt and effective treatment is a cornerstone of the current malaria control strategy. Delays in starting appropriate treatment is a major contributor to malaria mortality. WHO recommends home management of malaria using artemisininbased combination therapy (ACT) and Rapid Diagnostic tests (RDTs) as one of the strategies for improving access to prompt and efective malaria case management. Methods. A prospective evaluation of the effectiveness of using community health workers (CHWs) as delivery points for ACT and RDTs in the home management of malaria in two districts in Zambia. Results: CHWs were able to manage malaria fevers by correctly interpreting RDT results and appropriately prescribing antimalarials. All severe malaria cases and febrile non-malaria fevers were referred to a health facility for further management. There were variations in malaria prevalence between the two districts and among the villages in each district. 100% and 99.4% of the patients with a negative RDT result were not prescribed an antimalarial in the two districts respectively. No cases progressed to severe malaria and no deaths were recorded during the study period. Community perceptions were positive. Conclusion: CHWs are effective delivery points for prompt and effective malaria case management at community level. Adherence to test results is the best ever reported in Zambia. Further areas of implementation research are discussed. © 2011 Chanda et al; licensee BioMed Central Ltd. Source

Chanda P.,Ministry of Health Headquarters | Hamainza B.,Operational Research Unit | Moonga H.B.,Parasitology Unit | Chalwe V.,Tropical Diseases Research Center | And 2 more authors.
Malaria Journal

Background: Malaria case management is one of the key strategies to control malaria. Various studies have demonstrated the feasibility of home management of malaria (HMM). However, data on the costs and effectiveness of artemisinin-based combination therapy (ACT) and rapid diagnostic tests via HMM is limited. Method. Cost-effectiveness of home management versus health facility-based management of uncomplicated malaria in two rural districts in Zambia was analysed from a providers' perspective. The sample included 16 community health workers (CHWs) and 15 health facilities. The outcome measure was the cost per case appropriately diagnosed and treated. Costs of scaling-up HMM nationwide were estimated based on the CHW utilisation rates observed in the study. Results: HMM was more cost effective than facility-based management of uncomplicated malaria. The cost per case correctly diagnosed and treated was USD 4.22 for HMM and USD 6.12 for facility level. Utilization and adherence to diagnostic and treatment guidelines was higher in HMM than at a health facility. Conclusion: HMM using ACT and RDTs was more efficient at appropriately diagnosing and treating malaria than the health facility level. Scaling up this intervention requires significant investments. © 2011 Chanda et al; licensee BioMed Central Ltd. Source

Ssebunnya J.,Makerere University | Kigozi F.,Butabika National Referral and Teaching Mental Hospital | Ndyanabangi S.,Ministry of Health Headquarters | Cooper S.,University of Cape Town
International Journal of Culture and Mental Health

In Uganda, mental health has gained increased attention in recent years, with several new initiatives to improve services. The mental health system, however, still faces many shortcomings. The aim of this paper was to explore what a range of stakeholders perceive as the main challenges facing Uganda's mental health system and the primary ways of addressing them. A total of 62 interviews and six focus groups were conducted with stakeholders drawn from national and district levels. Thematic analysis of the data was conducted using a framework analysis approach. The participants identified a number of challenges facing Uganda's mental health system, which included an outdated mental health legislation; low priority of mental health; absence of a mental health policy; inadequate integration with primary health care; staffing shortages; stigma and discrimination; and neglect of child and adolescent mental health. Various contradictory views between stakeholders, and discrepancies between knowledge, policy and practice were revealed. Recommendations included: revising the mental health legislation; finalizing the mental health policy; training primary health care workers in mental health issues; sensitization in the community; and involvement of traditional healers. There is a need for increased attention towards closing the gap between mental health policy, knowledge and practice in Uganda. © 2011 Taylor & Francis. Source

Idro R.,Makerere University | Idro R.,University of Oxford | Namusoke H.,Makerere University | Abbo C.,Makerere University | And 8 more authors.
BMJ Open

Results: Patients with NS had had a longer duration of symptoms (median 5 (IQR 3, 6) years) compared with those with OCE (4 (IQR 2, 6) years), p<0.001. The intervention resulted in marked improvements in both groups; compared to the preintervention state, 121/484 (25%) patients with NS achieved seizure freedom and there was a >70% reduction in seizure frequency; behaviour and emotional difficulties resolved in 194/327 (59%) patients; 193/484 (40%) patients had enrolled in school including 17.7% who had earlier withdrawn due to severe seizures, and over 80% had achieved independence in basic self-care. These improvements were, however, less than that in patients with OCE of whom 243/476 (51.1%) patients were seizure free and in whom the seizure frequency had reduced by 86%.Conclusions: Ugandan children with NS show substantial clinical and functional improvements with symptomatic treatments suggesting that NS is probably a reversible encephalopathy.Objectives: Nodding syndrome (NS) is a poorly understood neurological disorder affecting thousands of children in Africa. In March 2012, we introduced a treatment intervention that aimed to provide symptomatic relief. This intervention included sodium valproate for seizures, management of behaviour and emotional difficulties, nutritional therapy and physical rehabilitation. We assessed the clinical and functional outcomes of this intervention after 12 months of implementation.Design: This was a cross-sectional study of a cohort of patients with NS receiving the specified intervention. We abstracted preintervention features from records and compared these with the current clinical status. We performed similar assessments on a cohort of patients with other convulsive epilepsies (OCE) and compared the outcomes of the two groups.Participants: Participants were patients with WHOdefined NS and patients with OCE attending the same centres.Outcome measures: The primary outcome was the proportion of patients with seizure freedom (≥1 month without seizures). Secondary outcome measures included a reduction in seizure frequency, resolution of behaviour and emotional difficulties, and independence in basic self-care. Source

Kigozi F.,Butabika National Referral and Teaching Mental Hospital | Ssebunnya J.,Makerere University | Kizza D.,Butabika National Referral and Teaching Mental Hospital | Cooper S.,University of Cape Town | Ndyanabangi S.,Ministry of Health Headquarters
International Journal of Mental Health Systems

Background: The Ugandan government recognizes mental health as a serious public health and development concern, and has of recent implemented a number of reforms aimed at strengthening the country's mental health system. The aim of this study was to provide a profile of the current mental health policy, legislation and services in Uganda.Methods: A survey was conducted of public sector mental health policy and legislation, and service resources and utilisation in Uganda, in the year 2005, using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS) Version 2.2.Results: Uganda's draft mental health policy encompasses many positive reforms, including decentralization and integration of mental health services into Primary Health Care (PHC). The mental health legislation is however outdated and offensive. Services are still significantly underfunded (with only 1% of the health expenditure going to mental health), and skewed towards urban areas. Per 100,000 population, there were 1.83 beds in mental hospitals, 1.4 beds in community based psychiatric inpatient units, and 0.42 beds in forensic facilities. The total personnel working in mental health facilities were 310 (1.13 per 100,000 population). Only 0.8% of the medical doctors and 4% of the nurses had specialized in psychiatry.Conclusion: Although there have been important developments in Uganda's mental health policy and services, there remains a number of shortcomings, especially in terms of resources and service delivery. There is an urgent need for more research on the current burden of mental disorders and the functioning of mental health programs and services in Uganda. © 2010 Kigozi et al; licensee BioMed Central Ltd. Source

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