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Background: Pedestrians in Uganda account for 40% of road traffic fatalities and 25% of serious injuries annually. We explored the current pedestrian road traffic injury interventions in Uganda to understand why pedestrian injuries and deaths continue despite the presence of interventions. Methods: We conducted a qualitative study that involved a desk review of road safety policy, regulatory documents, and reports. We supplemented the document review with 14 key informant interviews and 4 focus group discussions with par- ticipants involved in road safety. Qualitative thematic content analysis was done using ATLAS. ti 7 software. Results: Five thematic topics emerged. Specifically, Uganda had a Non-Motorized Transport Policy whose implementation revealed several gaps. The needs of pedestrians and contextual evidence were ignored in road systems. The key program- matic challenges in pedestrian road safety management included inadequate funding, lack of political support, and lack of stakeholder collaboration. There was no evidence of plans for monitoring and evaluation of the various pedestrian road safety interventions. Conclusion: The research revealed low prioritization of pedestrian needs in the design, implementation, and evaluation of pedestrian road safety interventions. Addressing Uganda’s pedestrian needs requires concerted efforts to coordinate all road safety activities, political commitment, and budgetary support at all levels. Keywords: Pedestrian; safety intervention; qualitative; Uganda.

Background Regulatory inspection of private drug shops in Uganda is a mandate of the Ministry of Health carried out by the National Drug Authority. This study evaluated how this mandate is being carried out at national, district, and drug shop levels. Specifically, perspectives on how the inspection is done, who does it, and challenges faced were sought from inspectors and drug sellers. Methods Six key informant interviews (KIIs) were held with inspectors at the national and district level, while eight focus group discussions (FGDs) were conducted among nursing assistants, and two FGDs were held with nurses. The study appraised current methods of inspecting drug sellers against national professional guidelines for licensing and renewal of class C drug shops in Uganda. Transcripts were managed using Atlas ti version 7 (ATLAS.ti GmbH, Berlin) data management software where the thematic content analysis was done. Results Five themes emerged from the study: authoritarian inspection, delegated inspection, licensing, training, and bribes. Under authoritarian inspection, drug sellers decried the high handedness used by inspectors when found with expired or no license at all. For delegated inspection, drug sellers said that sometimes, inspectors send health assistants and sub-county chiefs for inspection visits. This cadre of people is not recognized by law as inspectors. Inspectors trained drug sellers on how to organize their drug shops better and how to use new technologies such as rapid diagnostic tests (RDTs) in diagnosing malaria. Bribes were talked about mostly by nursing assistants who purported that inspectors were not interested in inspection per se but collecting illicit payments from them. Inspectors said that the facilitation they received from the central government were inadequate for a routine inspection. Conclusion The current method of inspecting drug sellers is harsh and instills fear among drug sellers. There is a need to establish a well-recognized structure of inspection as well as establish channels of dialogue between inspectors and drug sellers if meaningful compliance is to be achieved. The government also needs to enhance both human and financial resources if meaningful inspection of drug sellers is to take place.

Background Support supervision improves performance outcomes among health workers. However, the national professional guidelines for new licenses and renewal for Class C drug shops in Uganda prescribe self-supervision of licensed private drug sellers. Without support supervision, inappropriate treatment of malaria, pneumonia and diarrhoea among children under 5 years of age continues unabated. This study assessed experiences of drug sellers and peer supervisors at the end of a peer supervision intervention in Luuka District in East Central Uganda. Methods Eight in-depth interviews (IDIs) were held with peer supervisors while five focus group discussions (FGDs) were conducted among registered drug sellers at the end of the peer supervision intervention. The study assessed experiences and challenges of peer supervisors and drug sellers regarding peer supervision. Transcripts were imported into Atlas.ti 7 qualitative data management software where they were analysed using thematic content analysis. Results Initially, peer supervisors were disliked and regarded by drug sellers as another extension of drug inspectors. However, with time a good relationship was established between drug sellers and peer supervisors leading to regular, predictable and supportive peer supervision. This increased confidence of drug sellers in using respiratory timers and rapid diagnostic tests in diagnosing pneumonia symptoms and uncomplicated malaria, respectively, among children under 5 years. There was also an improvement in completing the sick child register which was used for self-assessment by drug sellers. The drug shop association was mentioned as a place where peer supervision should be anchored since it was a one-stop centre for sharing experiences and continuous professional development. Drug sellers proposed including community health workers in monthly drug shop association meetings so that they may also gain from the associated benefits. Untimely completion of the sick child registers by drug sellers and inadequate financial resources were the main peer supervision challenges mentioned. Conclusion Drug sellers benefitted from peer supervision by developing a good relationship with peer supervisors. This relationship guaranteed reliable and predictable supervision ultimately leading to improved treatment practices. There is need to explore the minimum resources needed for peer supervision of drug sellers to further inform practice and policy.

BackgroundExamining community perspective on an issue is not only a key consideration in research on road safety but also on other topics. There is substantial theoretical and empirical knowledge on built environment factors that contribute to pedestrian injury but how the community views these factors is least studied and constitutes the focus of this study. Our study investigated how respondents ranked the relative importance of selected built environment factors that contribute to pedestrian injury risk in Kampala city, Uganda and examined the underlying pattern behind the rankings.MethodsEight hundred and fifty-one pedestrians selected from 14 different road sections in Kampala city were asked to rank each of the 27 built environment variables on a 4-point Likert scale. Point score analysis was used to calculate scores for the different built environment variables and rank them in order of perceived contribution while factor analysis was used to determine the pattern underlying the responses.ResultsFactor analysis isolated two factors that explained 92% of the variation in respondents’ rankings: ‘road adjacent trip generators and attractors’ and ‘structure of traffic flows’. This finding implies that pedestrians in Kampala city perceived trip generators and attractors adjacent to the road and the structure of traffic flows as major explanations of the influence of the built environment on pedestrian injury risk.ConclusionWhile these rankings and factors identified may not necessarily equate to actual risk, they are important in providing an understanding of pedestrian injury risk from the perspective of the community.

Rationale aims and objectives: Appropriate treatment of pediatric fever in rural areas remains a challenge and maybe partly due to inadequate supervision of licensed drug sellers. This study assessed the effectiveness of peer-supervision among drug sellers on the appropriate treatment of pneumonia symptoms, uncomplicated malaria, and non-bloody diarrhea among children less than 5 years of age in the intervention (Luuka) and comparison (Buyende) districts, in East-Central Uganda. Methods: Data on pneumonia symptoms, uncomplicated malaria, and non-bloody diarrhea among children less than 5 years of age was abstracted from drug shop sick child registers over a 12-month period; 6 months before and 6 months after the introduction of peer-supervision. Interrupted time series were applied to determine the effectiveness of the peer-supervision intervention on the appropriate treatment of pneumonia, uncomplicated malaria, and non-bloody diarrhea among children less than 5 years of age attending drug shops in East Central Uganda. Results: The proportion of children treated appropriately for pneumonia symptoms was 10.84% (P

BackgroundPeer supervision improves health care delivery by health workers. However, in rural Uganda, self-supervision is what is prescribed for licensed private drug sellers by statutory guidelines. Evidence shows that self-supervision encourages inappropriate treatment of children less than 5 years of age by private drug sellers. This study constructed a model for an appropriate peer supervisor to augment the self-supervision currently practiced by drug sellers at district level in rural Uganda.MethodsIn this qualitative study, six Key informant interviews were held with inspectors while ten focus group discussions were conducted with 130 drug sellers. Data analysis was informed by the Kathy Charmaz constructive approach to grounded theory. Atlas ti.7 software package was used for data management.ResultsA model with four dimensions defining an appropriate peer supervisor was developed. The dimensions included; incentives, clearly defined roles, mediation and role model peer supervisor. While all dimensions were regarded as being important, all participants interviewed agreed that incentives for peer supervisors were the most crucial. Overall, an appropriate peer supervisor was described as being exemplary to other drug sellers, operated within a defined framework, well facilitated to do their role and a good go-between drug sellers and government inspectors.ConclusionFour central contributions advance literature by the model developed by our study. First, the model fills a supervision gap for rural private drug sellers. Second, it highlights the need for terms of reference for peer supervisors. Third, it describes who an appropriate peer supervisor should be. Lastly, it elucidates the kind of resources needed for peer supervision.

BackgroundPeer supervision improves health care delivery by health workers. However, in rural Uganda, self-supervision is what is prescribed for licensed private drug sellers by statutory guidelines. Evidence shows that self-supervision encourages inappropriate treatment of children less than five years of age by private drug sellers. This study constructed a model for an appropriate peer supervisor to augment the self-supervision currently practiced by drug sellers at district level in rural Uganda.MethodsIn this qualitative study, six Key informant interviews were held with inspectors while ten focus group discussions were conducted with one hundred and thirty drug sellers. Data analysis was informed by the Kathy Charmaz constructive approach to grounded theory. Atlas ti.7 software package was used for data management.Results A model with four dimensions defining an appropriate peer supervisor was developed. The dimensions included; incentives, clearly defined roles, mediation and role model peer supervisor. While all dimensions were regarded as being important, all participants interviewed agreed that incentives for peer supervisors were the most crucial. Overall, an appropriate peer supervisor was described as being exemplary to other drug sellers, operated within a defined framework, well facilitated to do their role and a good go-between drug sellers and government inspectors. Conclusion Four central contributions advance literature by the model developed by our study. First, the model fills a supervision gap for rural private drug sellers. Second, it highlights the need for terms of reference for peer supervisors. Third, it describes who an appropriate peer supervisor should be. Lastly, it elucidates the kind of resources needed for peer supervision.

Background: Appropriate treatment of paediatric fever in rural areas remains a challenge and may be partly due to inadequate supervision of licensed drug sellers. This study assessed the effectiveness of peer-supervision among drug sellers on appropriate treatment of pneumonia symptoms, uncomplicated malaria and non-bloody diarrhoea among children less than five years of age in the intervention (Luuka) and comparison (Buyende) districts, in East-Central Uganda.Methods: Data on pneumonia symptoms, uncomplicated malaria and non-bloody diarrhoea among children less than five years of age was abstracted from drug shop sick child registers over a 12-month period; six months before and six months after introduction of peer-supervision. Interrupted time series was applied to determine the effectiveness of the peer-supervision intervention on appropriate treatment of pneumonia, uncomplicated malaria and non-bloody diarrhoea among children less than five years of age attending drug shops in East Central Uganda.Results: The proportion of children treated appropriately for pneumonia symptoms was 10.84% (P Conclusions: Peer-supervision increased the proportion of children less than five years of age that received appropriate treatment for pneumonia symptoms but not for uncomplicated malaria and non-bloody diarrhoea. Implementation of community level interventions to improve paediatric fever management should consider including peer-supervision among drug sellers.

IntroductionIn Uganda, pedestrians are the most frequently injured category of road users, accounting for 40% of road traffic fatalities and 25% of serious injuries every year. There is paucity of information on existing pedestrian interventions and challenges that affect their implementation in Uganda. In this paper, we ascertain the state of pedestrian road safety interventions in Uganda and explore the challenges in the process of design, implementation, monitoring and evaluation of existing interventions.MethodsWe conducted a qualitative study that started with a desk review of existing policy documents, police statistics, media reports, non-governmental organization reports, and published research. We supplemented the review with 14 key informant interviews and 4 focus group discussions. Participants were drawn from various agencies and stakeholders responsible for road safety. In total, we collected and synthesized data on the design, implementation, and evaluation of pedestrian safety interventions from 25 documents. Data were analyzed using qualitative thematic content analysis.ResultsThe National Road Safety Council within the Ministry of Works and Transport is the lead agency tasked with coordinating all road safety efforts, while the Uganda Police is largely engaged in enforcing pedestrian safety. We identified several existing policies and regulations for pedestrian safety like the Non-Motorized Transport policy whose implementation has been inadequate. Implementation is constrained by weak institutional capacity and limited resources. Moreover, road safety stakeholders operated in silos and this hindered efforts to coordinate pedestrian safety activities. Interventions like road designs were implemented with limited reference to any supporting data and therefore did not cater for pedestrian needs.ConclusionThere are interventions targeting pedestrian safety in Uganda, but effective implementation is lacking or failing due to constraints related to weak institutional capacity. This necessitates strategies to mobilize resources to strengthen the capacity of the lead agency to effectively coordinate road safety interventions.

Background Globally, burn deaths are disproportionately higher among children below five years compared to other age groups. Although rarely fatal, most burns among this age group occur within the home environment specifically in the kitchen. Objective This study assessed the prevalence and factors associated with burns occurring at household level among under-fives living in Kisenyi, an urban slum in Kampala, Uganda. Methods A cross sectional study using both quantitative and qualitative methods was used. After stratification, simple random sampling was used to obtain a sample size of 426 children below 5 years. Purposive sampling was used to identify 6 key informants. Questionnaires, observation checklists and interview guides were used as data collection tools. A modified Poisson regression model was used to determine the correlates of burns. Findings Prevalence of burns was 32% and children aged 24 to 35 months (39%) were most affected. More boys (52.4%) had suffered burns. Children with single parents (adj PR=1.56 95% CI: 1.07–2.29) were more likely to suffer burns while those born to foreigners had a lower risk (adj.PR=0.5; 95% CI: 0.28–0.91). Households within the middle and richest wealth quintile (adj.PR=1.72; 95% CI: 1.02–2.89 and adj.PR=1.77; 95% CI: 1.02 to 3.05) had children with increased risk of burns. Through observation, households with flammables properly stored had a reduced a child’s burn injury likelihood (adj.PR=0.61; 95% CI: 0.44–0.83) when compared to their counterparts. Conclusion Prevalence of burns was high. Socio economic factors were shown to be more associated with childhood burns. Injury prevention efforts for similar urban slum settings should focus on community education and enforcement of home safety standards. Policy implication: In light of the high burn prevalence in Kisenyi slum, urban authorities should invest more in injury research so as to identify risk factors for burns. This scientific evidence once generated can be used for planning burn prevention programs.

Background Viral suppression is a critical indicator of HIV treatment success. In the era of test-and-start, little is known about treatment outcomes and time to undetectable viral loads. This study compares treatment outcomes, median times to achieve undetectable viral loads and its predictors under different antiretroviral (ART) treatment initiation schedules (i.e. within seven days of enrolment or later). Methods A retrospective cohort of 367 patients 5000 copies/ml were followed up for 60 months. Undetectable viral load measurements were based on both Roche (

The current qualitative study explored the perceptions of healthcare providers on screening for Intimate Partner Violence (IPV) in healthcare in Uganda, to develop a conceptual framework for factors likely to hinder/promote IPV screening in the country. Using purposive sampling, the study enlisted 54 healthcare workers (doctors and nurses) from four hospitals (i.e. Gulu referral hospital, Iganga referral hospital, Lacor hospital, Anaka hospital) to participate in eight focus group discussions. Data was thematically analysed using Template Analysis. The study found support for an ecological framework suggesting a complex interaction of factors at the individual (e.g. poor skills in detection of IPV by health workers and unwillingness to disclose abuse by patients), organisational (e.g. understaffing and lack of protocols for IPV screening) and societal (e.g. societal acceptance of abuse of women and poor policy on IPV management) levels as potential barriers to the practice of IPV screening in healthcare Uganda. These findings have important implications on further training of healthcare workers to adequately screen for IPV, re-organisation of the healthcare system so that it is fully-fledged to accommodate IPV screening and improved collaboration between the health sector and other community advocates in IPV management. These initiatives should run concurrently with a concerted community sensitization effort aimed at modifying attitudes towards IPV among care providers and recipients a like, as well as preparing the general population to will-fully disclose IPV to healthworkers. Study limitations and implications for further research are discussed.

Childhood injuries remain understudied in Uganda. The objective of this study was to determine the extent, nature and determinants of school-related childhood injury risk in north-western Uganda. A cohort of 1000 grade fives from 13 elementary schools was followed-up for one term. Survival and multi-level modelling techniques compared the risk rates across gender, schools and locations. Childhood injuries are common in north-western Uganda. Most of them occur during travel, breaks, practical classes and gardening, while walking, playing, learning and digging. Most injuries result from collisions with objects, sports and falls. Two-thirds of children receive first aid and hospital care. Times to injury were 72.1 and 192.9 person days (p = 0.0000). Gender differences in time to event were significant (p = 0.0091). Girls had better survival rates: cumulative prevalence of childhood injury was 36.1%; with significant gender differences (p = 0.007). Injury rate was 12.3/1000 person days, with a hazard ratio of 1.4. Compared to girls, boys had a 37% higher injury rate (p = 0.004). Rates varied among schools. Associated factors include sex and school. Rural-urban location and school differences do influence childhood injury risk. Childhood injuries are common: the risk is high, gender- and school-specific. Determinants include gender and school. Location and school contexts influence injury risk.

A number of instruments to assess healthcare workers readiness to screen for Intimate Partner Violence (IPV) in healthcare are now available to researchers. Before application in new settings however, pilot studies assessing their validity are warranted. : In this pilot study, we assessed the factorial structure and reliability of the Domestic Violence Healthcare Provider Survey Scale (DVHPSS) for future use in Uganda. Method: A convenient sample of healthcare workers at a referral hospital in Arua district, Uganda (n = 90) responded to the DVHPSS. Exploratory factor analysis using principle components and Cronbach’s alphas testing for internal reliability were applied on 86 complete individual responses to items of the DVHPSS. Bivariate correlations were run to assess scale distinctiveness. Results: All but one item of the DVHPSS exhibited significant factor loadings. Most subscales emerging from the factor analysis (i.e. Blame victim, professional role resistance and system support sub-scales) were congruent with the original scales. A split of the original victim/provider safety scale was however evident in the current data, forming two distinct scales i.e. victim and provider safety respectively. Items of the original perceived self-efficacy scale exhibited significant factor loadings but under separate factors, indicating that they may not be measuring a uni-dimensional concept in the Ugandan healthcare context. Conclusions: This data confirms the validity and reliability of the DVHSS for use in Uganda. It is how- ever recommended that items be scored in accordance to the specific sub-scales revealed in this study, to improve the structural validity of any assessment using the DVHPSS in Uganda.

Background: Unintentional Childhood Injuries pose a major public health challenge in Africa and Uganda. Previous estimates of the problem may have underestimated the childhood problem. We set to determine unintentional childhood injury pattern, odds, and outcomes at the National Paediatric Emergency unit in Kampala city using surveillance data. Methods: Incident proportions, odds and proportional rates were calculated and used to determine unintentional injury patterns across childhood (1-12 years). Results: A total of 556 cases recorded between January and May 2008 were analyzed: majority had been transported to hospital by mothers using mini-buses, private cars, and motorcycles. Median distance from injury location to hospital was 5 km. Homes, roads, and schools were leading injury locations. Males constituted 60% of the cases. Play and daily living activities were commonest injury time activities. Falls, burns and traffic accounted for 70.5% of unintentional childhood injuries. Burns, open wounds, fractures were commonest injury types. Motorcycles, buses and passenger-cars caused most crashes. Play grounds, furniture, stairs and trees were commonest source of falls. Most burn injuries were caused by liquids, fires and hot objects. 43.8% of cases were admitted. 30% were discharged without disability; 10%, were disabled; 1%, died. Injury odds and proportional incidence rates varied with age, place and cause. Poisoning and drowning were rare. Local pediatric injury priorities should include home, road and school safety. Conclusions: Unintentional injuries are common causes of hospital visit by children under 13 years especially boys. Homes, roads and educational facilities are commonest unintentional injury sites. Significant age and gender differences exist in intentional injury causation, characteristics and outcomes. In its current form, our surveillance system seems inefficient in capturing poisoning and drowning. The local prevention priorities could include home, road and school safety; especially dissemination and uptake of proven interventions. Burns should be focus of domestic injury prevention among under-fives. Commercial passenger motorcycles require better regulation and control.

Purpose To determine intentional injury burden, incident characteristics, and outcomes among Ugandan youth. Methods A cross sectional analysis of trauma registry data from accident and emergency units of five regional referral hospitals was conducted. Data had been prospectively collected from all patients accessing injury care at the five sites between July 2004 and June 2005: youth records were analysed. Results Intentional injuries among youth victims, especially school-age males, are common in all five regions, constituting 7.3% of their injury burden with a male dominance. Intentional youth victimisation mainly occurred at home, on roads, and in public places; incidents were largely due to blunt force, stabs/cuts, and gunshots in general, although variations in causes were evident depending on age. Intentional injuries among the youth victims often manifested as head, neck, and face injuries: 2% were severe and there were 4%case fatalities at 2 weeks. Conclusions and recommendations Intentional injuries among youth victims, especially school-age males, are important contributors of injury burden in all five sites. Homes, roads, and public places are unsafe for Ugandan youth. Although guns were used in all five sites, less lethal mechanisms (blunt force, stabs/cuts, and burns) are the most common with variations between locations. Incidents involving teenage housewives could reflect underlying problem of domestic violence. Community based studies could be highly informative. Youth should be prioritised for prevention of injuries both in and out of school.

Globally, 90% of road crash deaths occur in the developing world. Children in Africa bear the major part of this burden, with the highest unintentional injury rates in the world. Our study aims to better understand injury patterns among children living in Kampala, Uganda and provide evidence that injuries are significant in child health. Trauma registry records of injured children seen at Mulago Hospital in Kampala were analysed. Data were collected when patients were seen initially and included patient condition, demographics, clinical variables, cause, severity, as measured by the Kampala trauma score, and location of injury. Outcomes were captured on discharge from the casualty department and at two weeks for admitted patients. From August 2004 to August 2005, 872 injury visits for children

Background Despite the growing burden of injuries in LMICs, there are still limited primary epidemiologic data to guide health policy and health system development. Understanding the epidemiology of injury in developing countries can help identify risk factors for injury and target interventions for prevention and treatment to decrease disability and mortality. Aim To estimate the epidemiology of the injury seen in patients presenting to the government hospital inKampala, the capital city of Uganda. Methods A secondary analysis of a prospectively collected database collected by the Injury Control Centre-Uganda at the Mulago National Referral Hospital, Kampala, Uganda, 2004-2005. Results From 1 August 2004 to 12 August 2005, a total of 3,750 injury-related visits were recorded; a final sample of 3,481 records were analyzed. The majority of patients (62%) were treated in the casualty department and then discharged; 38% were admitted. Road traffic injuries (RTIs) were the most common causes of injury for all age groups in this sample, except for those under 5 years old, and accounted for 49% of total injuries. RTIs were also the most common cause of mortality in trauma patients. Within traffic injuries, more passengers (44%) and pedestrians (30%) were injured than drivers (27%). Other causes of trauma included blunt/penetrating injuries (25% of injuries) and falls (10%). Less than 5% of all patients arriving to the emergency department for injuries arrived by ambulance. Conclusions Road traffic injuries are by far the largest cause of both morbidity and mortality in Kampala. They are the most common cause of injury for all ages, except those younger than 5, and school-aged children comprise a large proportion of victims from these incidents. The integration of injury control programs with ongoing health initiatives is an urgent priority for health and development. © Springer-Verlag London Ltd 2010.

This pilot study assessed Mato-Oput5 (hereafter the curriculum), a new peace education curriculum, for indications of beneficial efficacy, specifically the capacity to reduce negative attitudes towards conflict and violence, and injury and violence rates. A cluster randomised control design was used. Three of the six purposively selected schools were exposed to the curriculum. Mato-Oput5 is a value-based, formalised curriculum taught by specifically trained teachers. Its learning areas include conflict, conscience, violence, non-violence, impulse control, anger management, kindness, forgiveness, empathy and reconciliation. The results showed the baseline and post-intervention bio-demographic characteristics of the treatment arms to be comparable, thus suggesting baseline group equivalence and randomisation success. The follow-up loss was 9%. The mean pre- and post-intervention intentional incident rates of the intervention and control groups were 270/1000 and 370/1000, and 190/1000 and 350/1000, respectively: these differences were not significant. The intervention had no effect on post-intervention intentional incident rates. There were indications of beneficial efficacy in the curriculum, especially its ability to cause attitude shifts in support of non-violence. Statistically significant behavioural effects were not detected although a downward rate trend was seen in the intervention group.

The study validated structure stability, reliability and sub-scale distinctiveness of integrated conflict and violence scale (ICVS) and was cross-sectional; war-affected grade 5 school children participated. ICV internal factorial validity and reliability were evaluated; eigenvalue size and scree plots were used for factor selection. A variable retention factor load threshold of >0.30 was used: Cronbach's alpha tests confirmed reliability increments. Pair-wise Pearson correlation tests evaluated sub-scale distinctiveness. Gulu University granted ethical clearance. A total of 280 grade 5 children from 50 primary schools participated: 53% of them were males. Two factors accounted for 100% of variability in attitudes; 18 variables were retained. Expelled variables were: 'If I catch some one stealing my sugar cane I will fight' and 'a bully should be forgiven'. Sub-scale internal consistency reliability coefficients were 0.73 and 0.65, respectively and distinctiveness correlation coefficient was -0.06. The ICVS was validated using standard criteria. Emerging two-factor scale has acceptable psychometric properties especially factorial structure, internal consistency and sub-scale distinctiveness.

Traffic injuries are an important problem in low income countries. In Uganda road traffic is the largest single cause of injury in Kampala; pedestrians, and children are most affected. Pedestrian injury affects school children in Uganda.To determine the overall risk of pedestrian traffic injury among school children in Kawempe, Uganda.A cohort was assembled at 35 primary schools and followed for 3 terms. Ten of the schools had participated in previous injury programs, others were systematically selected. Injuries were recorded by teachers using a questionnaire. Data collected included ID, school, age, grade, gender, incident date, vehicle type, and injury outcome. Demographic characteristics are described and cumulative incidences calculated.The cohort included 8,165 children (49% male) from 35 primary schools. The mean age was 9 years (Sd=2.78). Of the 35 schools, 92% were day; the others mixed day and boarding. 53 children (27 girls) were involved in a traffic incident. 25% of the injuries reported were serious and warranted care in a health facility. No deaths occurred. Forty % of incidents involved commercial motorcycles, 41% bicycles, 9% cars, 8% taxis, and 2% trucks. The cumulative incidence was 0.168% each term. Over the 3 terms of the year the cumulative incidence was 0.5 +/- 0.02. There were no gender differences in the cumulative incidence.Each school year about 1/2 % of Kawempe school children are involved in a traffic incident. Interventions are necessary to reduce the unacceptably high incidents of pedestrian traffic. Interventions to alleviate this situation including safer routes, teaching skills of road crossing to children as well as better regulation and road safety education to two wheelers could reduce the unacceptably high incidents of pedestrian traffic injury.

To estimate and compare the rate of pedestrian injuries in primary school-attending children of urban Uganda using different data sources.Data collection from a hospital-based trauma registry, police data, teacher reports, and a cross-sectional community-based survey.Kawempe, the largest urban district in the capital Kampala, Uganda. Patients orPrimary school-attending children aged 4-12 from 39 randomly selected schools were included in the trauma registry, police data, and teacher reports. 1828 households randomly selected from the 39 schools were interviewed for the community survey.A pedestrian injury. For the trauma registry-defined as a pedestrian injury resulting in a visit to the hospital. For the police data-defined as a pedestrian injury reported to the police. For the teacher reports and survey-defined as a pedestrian injury resulting in at least a day off school.The estimated pedestrian injury rates per 100 000 person-years were 54.0 (95% CI 25.3 to 117.4),53.97 (95% CI 23.8 to 125.9), 1878.8 (95% CI 1513.1 to 2322.4), and 764.0 (95% CI 523.3 to 1117.2) from the trauma registry, police data, teacher reports, and community survey, respectively.Pedestrian injury rates differed significantly between different data sources. Users must be aware of the different target populations, definitions, and limitations of the data sources before direct comparisons are made. Injury reports by volunteer teachers may be a feasible source of injury data in other low/middle-income countries.

Trauma remains a tremendous cause of morbidity and mortality in most countries. The objective of our study was to describe injury from trauma at the major referral hospital in Uganda over a 1-year period.Trauma registry forms have been completed for all trauma patients seen between August 2004 and July 2005 at the casualty department of Mulago Hospital in Kampala, Uganda. We also obtained 2-week follow-up data, and we compared these data with 1998 data from the same institution.In all, 3778 patients were entered into the database, with complete data available for 93.5% of patients. Patients had a mean age of 26 (standard deviation [SD] 12) years, and 75% of patients were male. The mean Kampala Trauma Score (KTS) was 9.1 (SD 1). We classified injuries as mild (82%; KTS 9-10), moderate (14%; KTS 7-8) and severe (4%; KTSor= 6). On arrival, 57% of patients were treated and sent home, 41.6% were admitted and 0.4% died in the casualty department. At 2-week follow-up, 85% were discharged, 12% were still in hospital and 2.7% had died. Causes of injury included road traffic collisions (50%), blunt force (15%), falls (10%), stab wounds (9%), animal bites (7%), burns (6%) and gunshot wounds (1%). Causes of mortality were road traffic collisions (61%), burns (15%), blunt trauma (8.6%), falls (6.5%), stabs/cuts (5.4%) and other (3.3%). Data from 1998 demonstrated a similar spectrum of injuries but with a mortality of 7.2%.Road traffic collisions are the greatest cause of morbidity and mortality from injury in Kampala, Uganda. When comparing data from 1998 and 2005, the spectrum of injury remained similar, but mortality decreased from 7.2% to 2.7%.

This study determined psychometric properties of 3-ET, an instrument specifically designed to track the effects of a curriculum support intervention created to enhance the delivery of the national curriculum in a war zone in Uganda. The instrument was developed through brain storm and expert review before being committed to structural and reliability testing using Exploratory Factor analysis (EFA). The 88 variables of 3-ET were reduced to 73; five distinct sub-scales emerged. Sub-scale 1, measured core education support functions and services. Sub-scale 2, assessed aesthetics/efficiency. Sub-scale 3, focused on barriers to stakeholder participation. Sub-scale 4 measured peacefulness and gender sensitivity of learning environments. Sub-scale 5 assessed pupil participation. 3-ET has acceptable structural validity and internal consistence reliability. It can be used to test effectiveness of the REPLICA intervention. Its applicability in other conflict and non-conflict contexts needs review.

To describe the pedestrian population, their use of an overpass, and to assess pedestrian perceptions and responses to the risk of traffic crashes, determine pedestrian injuries in relation to traffic flow, and compare traffic crash and pedestrian injury rates before and after the overpass construction.The study was conducted in Nakawa trading center approximately six kilometers from the center of Kampala city on a major highway. The trading center has a busy market, small retail shops, industries, a sports stadium, offices, low cost housing estates, schools, and an estimated population of 6,226 residents, 15.1% of them students.Pedestrian road behavior and traffic patterns were observed, and police traffic crash records reviewed, one year before and one year after overpass construction. A convenient sample of overpass and non-overpass users was interviewed to assess their perceptions of risk.A total of 13,064 pedestrians were observed (male: female ratio= 2.2:1). The overall prevalence of pedestrian overpass use was 35.4%. A bigger proportion of females (49.1%) crossed on the overpass compared to males (29.2%). More children (79.7%) than adults (27.3%) used the overpass. The majority of pedestrians (77.9%) were worried about their safety in traffic but only 6.6% thought of the overpass as an appropriate means to avoid traffic accidents. Traffic was not segregated by vehicle type. Mean traffic flow varied from 41.5 vehicles per minute between 0730-0830 hours, to 39.3 vehicles per minute between 1030-1130 hours and 37.7 vehicles per minute between 1730-1830 hours. The proportion of heavy vehicles (lorries, trailers, tankers, and tractors) increased from 3.3% of total vehicle volume in the morning to 5.4% in the evening (t = 2.847, p0.05); 44.0% of the collisions occurred in the evening with 35 pedestrian casualties before and 70 after the overpass intervention.The prevalence of pedestrian overpass use was low with adult males least likely to use it. Pedestrians had a high perception of risk, which did not seem to influence overpass use. Pedestrian were more likely to be injured during slow traffic flows. There were more traffic crashes, and pedestrian injuries, but fewer fatalities after the construction of the overpass.

Views and perceptions of rural (Ugandan elementary school) children and teachers regarding epidemiology (extent, risk, determinants, prevention), and management of childhood injuries were explored using FGDs and KII. Respondents thought childhood injuries and violations are common life experiences in North Western Uganda, linking them to contextual trends in staple food supply, social events, and sports. The contextual factors are thought to interact with individual, parental and situational variables to occasion the childhood and adolescent injury and violation patterns in North-western Uganda. The importance attached to injuries as community health concerns seemed to depend on the cause; in this regard, traffic injuries were viewed as most important concerns. Fatalistic thought was exhibited most with regard to those injuries viewed as most important. Local prevention and control resources and strategies do exist, most on ‘victim blame template’, which is known to be ineffective. Injury specific management strategies also exist; some of them are not ‘evidence based’ as understood in current scientific context but could be backed by local knowledge or rooted in indigenous practices as relate to community survival and coping strategies and mechanisms. Some of them could be harmful; rigorous profiling and review is recommended. Pre-hospital care training for elementary school teachers, caregivers (including parents) and other community resource persons is also recommended. Safer methods of mango harvesting, (grasshopper) hunting and sports need to be promoted. Child labour, corporal punishment, illicit drugs, fist fighting and sexual violation should be prioritised for prevention. Quantitative assessment of the childhood and adolescent injury and violation problem in Yumbe, North-western Uganda is recommended.

Unintentional Childhood Injury burden, outcomes and risks are assessed in Kampala. Proportional incidence rates, percentages and injury odds are computed; risk trends are constructed. Five hundred and fifty-six childhood injuries were recorded between January and May 2008. Male: female ratio was 15:10. Parents transported most patients to hospital using mini-buses, private cars and motorcycles. Median injury location was 5km. Homes, roads, schools were lead locations. Play and daily living activities are commonest injury time activities. Falls, burns and traffic constitute 70.5% of injuries. Burns, open wounds, fractures are commonest. Motorcycles, buses and passenger cars caused most crashes. Play grounds, furniture, stairs and trees were commonest fall sources. Liquids, fires and hot objects cause most burn. 43.8% of cases were admitted. 30% were not disabled; 10%, disabled; 1%, fatal. Injury odds varied with age, place and cause. We failed to capture poisoning and drowning. Local paediatric injury priorities should include home, road and school safety.