25 results on '"Namutamba, Sarah"'
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2. How a co-design process led to more contextually relevant family planning interventions in emerging urban settings in Eastern Uganda
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Ssanyu, Jacquellyn Nambi, Kananura, Rornald Muhumuza, Birabwa, Catherine, Kizito, Felix, Namutamba, Sarah, Akongo, Dorothy, Namara, Elizabeth, Kyangwa, Moses, Kaula, Henry, Nakimuli, Doreen, Magunda, Andrew, Kakaire, Othman, Waiswa, Peter, Ssanyu, Jacquellyn Nambi, Kananura, Rornald Muhumuza, Birabwa, Catherine, Kizito, Felix, Namutamba, Sarah, Akongo, Dorothy, Namara, Elizabeth, Kyangwa, Moses, Kaula, Henry, Nakimuli, Doreen, Magunda, Andrew, Kakaire, Othman, and Waiswa, Peter
- Abstract
Voluntary, rights-based family planning upholds women’s right to determine freely the number and spacing of their children. However, low-resource settings like Uganda still face a high unmet need for family planning. And, while urban areas are often indicated to have better access to health services, emerging evidence is revealing intra-urban socio-economic differentials in family planning utilization. To address the barriers to contraceptive use in these settings, understanding community-specific challenges and involving them in tailored intervention design is crucial. This paper describes the use of co-design, a human-centred design tool, to develop context-specific interventions that promote voluntary family planning in urban settings in Eastern Uganda. A five-stage co-design approach was used: 1) Empathize: primary data was collected to understand the problem and people involved, 2) Define: findings were shared with 56 participants in a three-day in-person co-design workshop, including community members, family planning service providers and leaders, 3) Ideate: workshop participants generated potential solutions, 4) Prototype: participants prioritized prototypes, and 5) Testing: user feedback was sought about the prototypes. A package of ten interventions was developed. Five interventions targeted demand-side barriers to family planning uptake, four targeted supply-side barriers, and one addressed leadership and governance barriers. Involving a diverse group of co-creators provided varied experiences and expertise to develop the interventions. Participants expressed satisfaction with their involvement in finding solutions to challenges in their communities. However, power imbalances and language barriers were identified by the participants as potential barriers to positive group dynamics and discussion quality. To address them, participants were separated into groups, and medical terminologies were simplified during brainstorming sessions. These changes improved
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- 2023
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3. Effect of community-level intervention on antenatal care attendance: a quasi-experimental study among postpartum women in Eastern Uganda
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Wafula, Solomon T, primary, Nalugya, Aisha, additional, Kananura, Rornald M, additional, Mugambe, Richard K, additional, Kyangwa, Moses, additional, Isunju, John B, additional, Kyobe, Betty, additional, Ssekamatte, Tonny, additional, Namutamba, Sarah, additional, Namazzi, Gertrude, additional, Ekirapa, Elizabeth K, additional, Musoke, David, additional, Walter, Florian, additional, and Waiswa, Peter, additional
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- 2022
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4. Understanding the contextual and cultural influences on women’s modern contraceptive use in East Uganda: A qualitative study
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Namasivayam, Amrita, primary, Schluter, Philip J., additional, Namutamba, Sarah, additional, and Lovell, Sarah, additional
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- 2022
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5. Effect of Community-Level Intervention on Early Initiation and Optimal Antenatal Care Attendance: A Quasi-Experimental Study Among Post-Partum Women in Eastern Uganda
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Wafula, Solomon T, primary, Nalugya, Aisha, additional, Kananura, Rornald M, additional, Mugambe, Richard K, additional, Kyangwa, Moses, additional, Isunju, John B, additional, Kyobe, Betty, additional, Ssekamatte, Tonny, additional, Namutamba, Sarah, additional, Namazzi, Gertrude, additional, Ekirapa, Elizabeth K, additional, Musoke, David, additional, Walter, Florian, additional, and Waiswa, Peter, additional
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- 2021
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6. Predictors of modern contraceptive use among women and men in Uganda: a population-level analysis
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Namasivayam, Amrita, primary, Lovell, Sarah, additional, Namutamba, Sarah, additional, and Schluter, Philip J, additional
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- 2020
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7. “A sweet in a polythene is not sweet”: men’s perceptions of their roles and experiences with family planning in East Uganda.
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Namasivayam, Amrita, Schluter, Philip J., Namutamba, Sarah, and Lovell, Sarah
- Abstract
AbstractThe significance of men’s influence as partners in contraceptive decision-making and family size is often understated, particularly in patriarchal societies. Understanding men’s experiences and perceptions of family planning is necessary to address women’s unmet needs for contraception. This study examined men’s involvement in contraceptive use and decision-making in the Busoga region of east Uganda. Twenty-four in-depth interviews were conducted with both male users and non-users of contraception living in urban and rural areas. Among participants, differences in preferred family size were influenced by competing norms valuing large families and economic wellbeing as reflections of men’s role as a provider. Although the majority of interviewees were not opposed in principle to contraception, some men felt contraceptives undermined their own desire for a larger family. Men who supported family planning cited the economic benefits of smaller, healthier families and being able to fulfil their role as the primary breadwinner. Resistance to vasectomy and perceptions of condom use as protection against unwanted pregnancies and STIs/HIV in casual relationships, meant participants were unlikely to use male contraceptives. Efforts to increase contraceptive uptake among men should recognise the socio-cultural context of men’s place within Ugandan society, to design reproductive health initiatives that engage men effectively. [ABSTRACT FROM AUTHOR]
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- 2024
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8. Improved contraceptive use among women and men in Uganda between 1995-2016: A repeated cross-sectional population study
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Namasivayam, Amrita, primary, Lovell, Sarah, additional, Namutamba, Sarah, additional, and Schluter, Philip J., additional
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- 2019
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9. Working with community health workers to improve maternal and newborn health outcomes : implementation and scale-up lessons from eastern Uganda
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Namazzi, Gertrude, Okuga, Monica, Tetui, Moses, Kananura, Rornald Muhumuza, Kakaire, Ayub, Namutamba, Sarah, Mutebi, Aloysius, Kiwanuka, Suzanne Namusoke, Ekirapa-Kiracho, Elizabeth, Waiswa, Peter, Namazzi, Gertrude, Okuga, Monica, Tetui, Moses, Kananura, Rornald Muhumuza, Kakaire, Ayub, Namutamba, Sarah, Mutebi, Aloysius, Kiwanuka, Suzanne Namusoke, Ekirapa-Kiracho, Elizabeth, and Waiswa, Peter
- Abstract
Background: Preventable maternal and newborn deaths can be averted through simple evidence-based interventions, such as the use of community health workers (CHWs), also known in Uganda as village health teams. However, the CHW strategy faces implementation challenges regarding training packages, supervision, and motivation. Objectives: This paper explores knowledge levels of CHWs, describes the coverage of home visits, and shares lessons learnt from setting up and implementing the CHW strategy. Methods: The CHWs were trained to conduct four home visits: two during pregnancy and two after delivery. The aim of the visits was to promote birth preparedness and utilization of maternal and newborn health (MNH) services. Mixed methods of data collection were employed. Quantitative data were analyzed using Stata version 13.0 to determine the level and predictors of CHW knowledge of MNH. Qualitative data from 10 key informants and 15 CHW interviews were thematically analyzed to assess the implementation experiences. Results: CHWs' knowledge of MNH improved from 41.3% to 77.4% after training, and to 79.9% 1 year post-training. However, knowledge of newborn danger signs declined from 85.5% after training to 58.9% 1 year later. The main predictors of CHW knowledge were age (>= 35 years) and post-primary level of education. The level of coverage of at least one CHW visit to pregnant and newly delivered mothers was 57.3%. Notably, CHW reports complemented the facility-based health information. CHWs formed associations, which improved teamwork, reporting, and general performance, and thus maintained low dropout rates at 3.6%. Challenges included dissatisfaction with the quarterly transport refund of 6 USD and lack of means of transportation such as bicycles. Conclusions: CHWs are an important resource in community-based health information and improving demand for MNH services. However, the CHW training and supervision models require strengthening for improved performance. Local, Supplement: 4Special Issue: MANIFEST (Maternal and Neonatal Implementation for Equitable Systems Study)
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- 2017
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10. Working with community health workers to improve maternal and newborn health outcomes: implementation and scale-up lessons from eastern Uganda
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Namazzi, Gertrude, primary, Okuga, Monica, additional, Tetui, Moses, additional, Muhumuza Kananura, Rornald, additional, Kakaire, Ayub, additional, Namutamba, Sarah, additional, Mutebi, Aloysius, additional, Namusoke Kiwanuka, Suzanne, additional, Ekirapa-Kiracho, Elizabeth, additional, and Waiswa, Peter, additional
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- 2017
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11. Community-made mobile videos as a mechanism for maternal, newborn and child health education in rural Uganda; a qualitative evaluation
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Mutanda, Juliet Ntuulo, primary, Waiswa, Peter, additional, and Namutamba, Sarah, additional
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- 2017
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12. Effect of the Uganda Newborn Study on care-seeking and care practices: a cluster-randomised controlled trial
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Kerber, Kate, Peterson, Stefan, Waiswa, Peter, Lawn, Joy E., Sankoh, Osman, Claeson, Mariam, Pariyo, George, Kallander, Karin, Akuze, Joseph, Namazzi, Gertrude, Ekirapa-Kiracho, Elizabeth, Sengendo, Hanifah, Aliganyira, Patrick, Okuga, Monica, Kemigisa, Margaret, Namutamba, Sarah, Timša, Līga, Marrone, Gaetano, Ekirapa, Elizabeth, Nakakeeto, Margaret, Nakibuuka, Victoria K., Najjemba, Maria, Namusaabi, Ruth, Tagoola, Abner, Nakate, Grace, Ajeani, Judith, Byaruhanga, Romano N., Tetui, Moses, Forsberg, Birger C., Hanson, Claudia, Kiguli, Juliet, Namusoko, Sarah, Nalwadda, Christine K., Guwatudde, David, Sitrin, Deborah, Guenther, Tanya, Sharma, Srijana, Ashish, KC, Rubayet, Sayed, Bhadra, Subrata, Ligowe, Reuben, Chimbalanga, Emmanuel, Sewell, Elizabeth, and Moran, Allisyn
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neonatal mortality ,newborn health ,essential newborn care ,Newborn Health in Uganday ,care-seeking ,maternal health ,neonatal ,community health worker ,private health care ,community health workers ,kangaroo mother care ,formative research ,antenatal care ,newborn ,sociocultural influences ,postnatal care ,community-based ,Uganda ,traditional birth attendants ,public health care ,postnatal ,birth preparedness ,health policy ,Newborn Health in Uganda ,home visit ,postpartum depression ,health system strengthening ,newborn care ,qualitative ,stillbirth ,referral ,Special Issue: Newborn Health in Uganda ,maternal care ,pregnancy ,pregnancy loss ,randomised controlled trial - Abstract
Background Care for women and babies before, during, and after the time of birth is a sensitive measure of the functionality of any health system. Engaging communities in preventing newborn deaths is a promising strategy to achieve further progress in child survival in sub-Saharan Africa. Objective To assess the effect of a home visit strategy combined with health facility strengthening on uptake of newborn care-seeking, practices and services, and to link the results to national policy and scale-up in Uganda. Design The Uganda Newborn Study (UNEST) was a two-arm cluster-randomised controlled trial in rural eastern Uganda. In intervention villages volunteer community health workers (CHWs) were trained to identify pregnant women and make five home visits (two during pregnancy and three in the first week after birth) to offer preventive and promotive care and counselling, with extra visits for sick and small newborns to assess and refer. Health facility strengthening was done in all facilities to improve quality of care. Primary outcomes were coverage of key essential newborn care behaviours (breastfeeding, thermal care, and cord care). Analyses were by intention to treat. This study is registered as a clinical trial, number ISRCTN50321130. Results The intervention significantly improved essential newborn care practices, although many interventions saw major increases in both arms over the study period. Immediate breastfeeding after birth and exclusive breastfeeding were significantly higher in the intervention arm compared to the control arm (72.6% vs. 66.0%; p=0.016 and 81.8% vs. 75.9%, p=0.042, respectively). Skin-to-skin care immediately after birth and cord cutting with a clean instrument were marginally higher in the intervention arm versus the control arm (80.7% vs. 72.2%; p=0.071 and 88.1% vs. 84.4%; p=0.023, respectively). Half (49.6%) of the mothers in the intervention arm waited more than 24 hours to bathe the baby, compared to 35.5% in the control arm (p, Background There is a lack of literature on how to adapt new evidence-based interventions for maternal and newborn care into local health systems and policy for rapid scale-up, particularly for community-based interventions in low-income settings. The Uganda Newborn Study (UNEST) was a cluster randomised control trial to test a community-based care package which was rapidly taken up at national level. Understanding this process may help inform other studies looking to design and evaluate with scale-up in mind. Objective This study aimed to describe the process of using evidence to design a community-based maternal and newborn care package in rural eastern Uganda, and to determine the dissemination and advocacy approaches used to facilitate rapid policy change and national uptake. Design We reviewed UNEST project literature including meeting reports and minutes, supervision reports, and annual and midterm reports. National stakeholders, project and district staff were interviewed regarding their role in the study and perceptions of what contributed to uptake of the package under evaluation. Data related to UNEST formative research, study design, implementation and policy influence were extracted and analysed. Results An advisory committee of key players in development of maternal and newborn policies and programmes in Uganda was constituted from many agencies and disciplines. Baseline qualitative and quantitative data collection was done at district, community and facility level to examine applicability of aspects of a proposed newborn care package to the local setting. Data were summarised and presented to stakeholders to adapt the intervention that was ultimately tested. Quarterly monitoring of key activities and events around the interventions were used to further inform implementation. The UNEST training package, home visit schedule and behaviour change counselling materials were incorporated into the national Village Health Team and Integrated Community Case Management packages while the study was ongoing. Conclusions Designing interventions for national scale-up requires strategies and planning from the outset. Use of evidence alongside engagement of key stakeholders and targeted advocacy about the burden and potential solutions is important when adapting interventions to local health systems and communities. This approach has the potential to rapidly translate research into policy, but care must be taken not to exceed available evidence while seizing the policy opportunity., Background Community health workers (CHWs) have been employed in a number of low- and middle-income countries as part of primary health care strategies, but the packages vary across and even within countries. The experiences and motivations of a multipurpose CHW in providing maternal and newborn health have not been well described. Objective This study examined the perceptions of community members and experiences of CHWs around promoting maternal and newborn care practices, and the self-identified factors that influence the performance of CHWs so as to inform future study design and programme implementation. Design Data were collected using in-depth interviews with six local council leaders, ten health workers/CHW supervisors, and eight mothers. We conducted four focus group discussions with CHWs. Respondents included 14 urban and 18 rural CHWs. Key themes explored included the experience of CHWs according to their various roles, and the facilitators and barriers they encounter in their work particular to provision of maternal and newborn care. Qualitative data were analysed using manifest content analysis methods. Results CHWs were highly appreciated in the community and seen as important contributors to maternal and newborn health at grassroots level. Factors that positively influence CHWs included being selected by and trained in the community; being trained in problem-solving skills; being deployed immediately after training with participation of local leaders; frequent supervision; and having a strengthened and responsive supply of services to which families can be referred. CHWs made use of social networks to identify pregnant and newly delivered women, and were able to target men and the wider family during health education activities. Intrinsic motivators (e.g. community appreciation and the prestige of being ‘a doctor’), monetary (such as a small transport allowance), and material incentives (e.g. bicycles, bags) were also important to varying degrees. Conclusions There is a continued role for CHWs in improving maternal and newborn care and linking families with health services. However, the process for building CHW programmes needs to be adapted to the local setting, including the process of training, deployment, supervision, and motivation within the context of a responsive and available health system., Background Promotion of birth preparedness and raising awareness of potential complications is one of the main strategies to enhance the timely utilisation of skilled care at birth and overcome barriers to accessing care during emergencies. Objective This study aimed to investigate factors associated with birth preparedness in three districts of eastern central Uganda. Design This was a cross-sectional baseline study involving 2,010 women from Iganga [community health worker (CHW) strategy], Buyende (vouchers for transport and services), and Luuka (standard care) districts who had delivered within the past 12 months. ‘Birth prepared’ was defined as women who had taken all of the following three key actions at least 1 week prior to the delivery: 1) chosen where to deliver from; 2) saved money for transport and hospital costs; and 3) bought key birth materials (a clean instrument to cut the cord, a clean thread to tie the cord, cover sheet, and gloves). Logistical regression was performed to assess the association of various independent variables with birth preparedness. Results Only about 25% of respondents took all three actions relating to preparing for childbirth, but discrete actions (e.g. financial savings and identification of place to deliver) were taken by 75% of respondents. Variables associated with being prepared for birth were: having four antenatal care (ANC) visits [adjusted odds ratio (ORA)=1.42; 95% confidence interval (CI) 1.10–1.83], attendance of ANC during the first (ORA=1.94; 95% CI 1.09–3.44) or second trimester (ORA=1.87; 95% CI 1.09–3.22), and counselling on danger signs during pregnancy or on place of referral (ORA=2.07; 95% CI 1.57–2.74). Other associated variables included being accompanied by one's husband to the place of delivery (ORA=1.47; 95% CI 1.15–1.89), higher socio-economic status (ORA=2.04; 95% CI 1.38–3.01), and having a regular income (ORA=1.83; 95% CI 1.20–2.79). Women from Luuka and Buyende were less likely to have taken three actions compared with women from Iganga (ORA=0.72; 95% CI 0.54–0.98 and ORA=0.37; 95% CI 0.27–0.51, respectively). Conclusions Engaging CHWs and local structures during pregnancy may be an effective strategy in promoting birth preparedness. On the other hand, if not well designed, the use of vouchers could disempower families in their efforts to prepare for birth. Other effective strategies for promoting birth preparedness include early ANC attendance, attending ANC at least four times, and male involvement., Background In Uganda maternal and neonatal mortality remains high due to a number of factors, including poor quality of care at health facilities. Objective This paper describes the experience of building capacity for maternal and newborn care at a district hospital and lower-level health facilities in eastern Uganda within the existing system parameters and a robust community outreach programme. Design This health system strengthening study, part of the Uganda Newborn Study (UNEST), aimed to increase frontline health worker capacity through district-led training, support supervision, and mentoring at one district hospital and 19 lower-level facilities. A once-off supply of essential medicines and equipment was provided to address immediate critical gaps. Health workers were empowered to requisition subsequent supplies through use of district resources. Minimal infrastructure adjustments were provided. Quantitative data collection was done within routine process monitoring and qualitative data were collected during support supervision visits. We use the World Health Organization Health System Building Blocks to describe the process of district-led health facility strengthening. Results Seventy two per cent of eligible health workers were trained. The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later. Health worker skills and competencies in care of high-risk babies improved following support supervision and mentoring. Health facility deliveries increased from 3,151 to 4,115 (a 30% increase) in 2 years. Of 547 preterm babies admitted to the newly introduced kangaroo mother care (KMC) unit, 85% were discharged alive to continue KMC at home. There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period. While equipment levels remained high after initial improvement efforts, maintaining supply of even the most basic medications was a challenge, with less than 40% of health facilities reporting no stock-outs. Conclusion Health system strengthening for care at birth and the newborn period is possible even in low-resource settings and can be associated with improved utilisation and outcomes. Through a participatory process with wide engagement, training, and improvements to support supervision and logistics, health workers were able to change behaviours and practices for maternal and newborn care. Local solutions are needed to ensure sustainability of medical commodities., Background In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth. Objective To describe the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda. Design Within a community-based maternal and newborn care intervention with health systems strengthening, we collected data from mothers with infants at baseline and endline using a structured questionnaire. Descriptive, bivariate, and multivariate data analysis comparing nine newborn care practices and three composite newborn care indicators among private and public health facilities was conducted. Results The proportion of women giving birth at private facilities decreased from 25% at baseline to 17% at endline, whereas overall facility births increased. Private health facilities did not perform significantly better than public health facilities in terms of coverage of any essential newborn care interventions, and babies were more likely to receive thermal care practices in public facilities compared to private (68% compared to 60%, p=0.007). Babies born at public health facilities received an average of 7.0 essential newborn care interventions compared to 6.2 at private facilities (p, Background Stillbirths do not register amongst national or global public health priorities, despite large numbers and known solutions. Although not accounted in statistics – these deaths count for families. Part of this disconnect is that very little is known about the lived experiences and perceptions of those experiencing this neglected problem. Objective This study aimed to explore local definitions and perceived causes of stillbirths as well as coping mechanisms used by families affected by stillbirth in rural eastern Uganda. Design A total of 29 in-depth interviews were conducted with women who had a stillbirth (14), men whose wives experienced a stillbirth (6), grandmothers (4), grandfathers (1), and traditional birth attendants (TBAs) (4). Participants were purposively recruited from the hospital maternity ward register, with additional recruitment done through community leaders and other participants. Data were analysed using content analysis. Results Women and families affected by stillbirth report pregnancy loss as a common occurrence. Definitions and causes of stillbirth included the biomedical, societal, and spiritual. Disclosure of stillbirth varies with women who experience consecutive or multiple losses, subject to potential exclusion from the community and even the family. Methods for coping with stillbirth were varied and personal. Ritual burial practices were common, yet silent and mainly left to women, as opposed to public mourning for older children. There were no formal health system mechanisms to support or care for families affected by stillbirths. Conclusion In a setting with strong collective ties, stillbirths are a burden borne by the affected family, and often just by the mother, rather than the community as a whole. Strategies are needed to address preventable stillbirths as well as to follow up with supportive services for those affected., Background The first week of life is the time of greatest risk of death and disability, and is also associated with many traditional beliefs and practices. Identifying sick newborns in the community and referring them to health facilities is a key strategy to reduce deaths. Although a growing area of interest, there remains a lack of data on the role of sociocultural norms and practices on newborn healthcare-seeking in sub-Saharan Africa and the extent to which these norms can be modified. Objective This study aimed to understand the community's perspective of potential sociocultural barriers and facilitators to compliance with newborn referral. Method In this qualitative study, focus group discussions (n=12) were conducted with mothers and fathers of babies aged less than 3 months. In addition, in-depth interviews (n=11) were also held with traditional birth attendants and mothers who had been referred by community health workers to seek health-facility-based care. Participants were purposively selected from peri-urban and rural communities in two districts in eastern Uganda. Data were analysed using latent content analysis. Results The community definition of a newborn varied, but this was most commonly defined by the period between birth and the umbilical cord stump falling off. During this period, newborns are perceived to be vulnerable to the environment and many mothers and their babies are kept in seclusion, although this practice may be changing. Sociocultural factors that influence compliance with newborn referrals to seek care emerged along three sub-themes: community understanding of the newborn period and cultural expectations; the role of community health actors; and caretaker knowledge, experience, and decision-making autonomy. Conclusion In this setting, there is discrepancy between biomedical and community definitions of the newborn period. There were a number of sociocultural factors that could potentially affect compliance to newborn referral. The widely practised cultural seclusion period, knowledge about newborn sickness, individual experiences in households, perceived health system gaps, and decision-making processes were facilitators of or barriers to compliance with newborn referral. Designers of newborn interventions need to address locally existing cultural beliefs at the same time as they strengthen facility care., Background Nearly all newborn deaths occur in low- or middle-income countries. Many of these deaths could be prevented through promotion and provision of newborn care practices such as thermal care, early and exclusive breastfeeding, and hygienic cord care. Home visit programmes promoting these practices were piloted in Malawi, Nepal, Bangladesh, and Uganda. Objective This study assessed changes in selected newborn care practices over time in pilot programme areas in four countries and evaluated whether women who received home visits during pregnancy were more likely to report use of three key practices. Design Using data from cross-sectional surveys of women with live births at baseline and endline, the Pearson chi-squared test was used to assess changes over time. Generalised linear models were used to assess the relationship between the main independent variable – home visit from a community health worker (CHW) during pregnancy (0, 1–2, 3+) – and use of selected practices while controlling for antenatal care, place of delivery, and maternal age and education. Results There were statistically significant improvements in practices, except applying nothing to the cord in Malawi and early initiation of breastfeeding in Bangladesh. In Malawi, Nepal, and Bangladesh, women who were visited by a CHW three or more times during pregnancy were more likely to report use of selected practices. Women who delivered in a facility were also more likely to report use of selected practices in Malawi, Nepal, and Uganda; association with place of birth was not examined in Bangladesh because only women who delivered outside a facility were asked about these practices. Conclusion Home visits can play a role in improving practices in different settings. Multiple interactions are needed, so programmes need to investigate the most appropriate and efficient ways to reach families and promote newborn care practices. Meanwhile, programmes must take advantage of increasing facility delivery rates to ensure that all babies benefit from these practices.
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- 2015
13. Health System Preparedness for Newborn Care: A Health Facility Assessment in Rural Uganda
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Nalwadda, Christine Kayemba, primary, Tomson, Göran, additional, Kiguli, Juliet, additional, Namugaya, Faith, additional, Namazzi, Gertrude, additional, Namutamba, Sarah, additional, Nambuya, Harriet, additional, Tagoola, Abner, additional, Peterson, Stefan, additional, and Waiswa, Peter, additional
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- 2016
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14. Strengthening health facilities for maternal and newborn care : experiences from rural eastern Uganda
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Namazzi, Gertrude, Waiswa, Peter, Nakakeeto, Margaret, Nakibuuka, Victoria K, Namutamba, Sarah, Najjemba, Maria, Namusaabi, Ruth, Tagoola, Abner, Nakate, Grace, Ajeani, Judith, Peterson, Stefan, Byaruhanga, Romano N, Namazzi, Gertrude, Waiswa, Peter, Nakakeeto, Margaret, Nakibuuka, Victoria K, Namutamba, Sarah, Najjemba, Maria, Namusaabi, Ruth, Tagoola, Abner, Nakate, Grace, Ajeani, Judith, Peterson, Stefan, and Byaruhanga, Romano N
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BACKGROUND: In Uganda maternal and neonatal mortality remains high due to a number of factors, including poor quality of care at health facilities. OBJECTIVE: This paper describes the experience of building capacity for maternal and newborn care at a district hospital and lower-level health facilities in eastern Uganda within the existing system parameters and a robust community outreach programme. DESIGN: This health system strengthening study, part of the Uganda Newborn Study (UNEST), aimed to increase frontline health worker capacity through district-led training, support supervision, and mentoring at one district hospital and 19 lower-level facilities. A once-off supply of essential medicines and equipment was provided to address immediate critical gaps. Health workers were empowered to requisition subsequent supplies through use of district resources. Minimal infrastructure adjustments were provided. Quantitative data collection was done within routine process monitoring and qualitative data were collected during support supervision visits. We use the World Health Organization Health System Building Blocks to describe the process of district-led health facility strengthening. RESULTS: Seventy two per cent of eligible health workers were trained. The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later. Health worker skills and competencies in care of high-risk babies improved following support supervision and mentoring. Health facility deliveries increased from 3,151 to 4,115 (a 30% increase) in 2 years. Of 547 preterm babies admitted to the newly introduced kangaroo mother care (KMC) unit, 85% were discharged alive to continue KMC at home. There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period. While equipment levels remained high after initial improvement efforts, maintaining supply of even the most basic medications was a challenge, with less than 40% of
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- 2015
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15. Improving newborn care practices through home visits: lessons from Malawi, Nepal, Bangladesh, and Uganda
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Sitrin, Deborah, primary, Guenther, Tanya, additional, Waiswa, Peter, additional, Namutamba, Sarah, additional, Namazzi, Gertrude, additional, Sharma, Srijana, additional, Ashish, KC, additional, Rubayet, Sayed, additional, Bhadra, Subrata, additional, Ligowe, Reuben, additional, Chimbalanga, Emmanuel, additional, Sewell, Elizabeth, additional, Kerber, Kate, additional, and Moran, Allisyn, additional
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- 2015
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16. Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda
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Namazzi, Gertrude, primary, Waiswa, Peter, additional, Nakakeeto, Margaret, additional, Nakibuuka, Victoria K., additional, Namutamba, Sarah, additional, Najjemba, Maria, additional, Namusaabi, Ruth, additional, Tagoola, Abner, additional, Nakate, Grace, additional, Ajeani, Judith, additional, Peterson, Stefan, additional, and Byaruhanga, Romano N., additional
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- 2015
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17. Engaging community health workers in maternal and newborn care in eastern Uganda
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Okuga, Monica, primary, Kemigisa, Margaret, additional, Namutamba, Sarah, additional, Namazzi, Gertrude, additional, and Waiswa, Peter, additional
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- 2015
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18. Health system preparedness for newborn care : a health facility assessment in rural Uganda
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Nalwadda, Christine Kayemba, Peterson, Stefan, Tomson, Goran, Guwatudde, David, Kiguli, Juliet, Namazzi, Gertrude, Namutamba, Sarah, Namugaya, Faith, Nambuya, Harriet, Tagoola, Abnet, Waiswa, Peter, Nalwadda, Christine Kayemba, Peterson, Stefan, Tomson, Goran, Guwatudde, David, Kiguli, Juliet, Namazzi, Gertrude, Namutamba, Sarah, Namugaya, Faith, Nambuya, Harriet, Tagoola, Abnet, and Waiswa, Peter
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- 2014
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19. Community-made mobile videos as a mechanism for maternal, newborn and child health education in rural Uganda; a qualitative evaluation.
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Ntuulo Mutanda, Juliet, Waiswa, Peter, and Namutamba, Sarah
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- 2016
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20. Health system preparedness for newborn care: a health facility assessment in rural Uganda
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Nalwadda, Christine Kayemba, primary, Peterson, Stefan, additional, Tomson, Goran, additional, Guwatudde, David, additional, Kiguli, Juliet, additional, Namazzi, Gertrude, additional, Namutamba, Sarah, additional, Namugaya, Faith, additional, Nambuya, Harriet, additional, Tagoola, Abner, additional, and Waiswa, Peter, additional
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- 2014
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21. High Compliance with Newborn Community-to-Facility Referral in Eastern Uganda : An Opportunity to Improve Newborn Survival
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Nalwadda, Christine Kayemba, Waiswa, Peter, Kiguli, Juliet, Namazzi, Gertrude, Namutamba, Sarah, Tomson, Göran, Peterson, Stefan, Guwatudde, David, Nalwadda, Christine Kayemba, Waiswa, Peter, Kiguli, Juliet, Namazzi, Gertrude, Namutamba, Sarah, Tomson, Göran, Peterson, Stefan, and Guwatudde, David
- Abstract
BACKGROUND: Seventy-five percent of newborn deaths happen in the first-week of life, with the highest risk of death in the first 24-hours after birth.WHO and UNICEF recommend home-visits for babies in the first-week of life to assess for danger-signs and counsel caretakers for immediate referral of sick newborns. We assessed timely compliance with newborn referrals made by community-health workers (CHWs), and its determinants in Iganga and Mayuge Districts in rural eastern Uganda. METHODS: A historical cohort study design was used to retrospectively follow up newborns referred to health facilities between September 2009 and August 2011. Timely compliance was defined as caretakers of newborns complying with CHWs' referral advice within 24-hours. RESULTS: A total of 724 newborns were referred by CHWs of whom 700 were successfully traced. Of the 700 newborns, 373 (53%) were referred for immunization and postnatal-care, and 327 (47%) because of a danger-sign. Overall, 439 (63%) complied, and of the 327 sick newborns, 243 (74%) caretakers complied with the referrals. Predictors of referral compliance were; the newborn being sick at the time of referral- Adjusted Odds Ratio (AOR) = 2.3, and 95% Confidence-Interval (CI) of [1.6 - 3.5]), the CHW making a reminder visit to the referred newborn shortly after referral (AOR =1.7; 95% CI: [1.2 -2.7]); and age of mother (25-29) and (30-34) years, (AOR =0.4; 95% CI: [0.2 - 0.8]) and (AOR = 0.4; 95% CI: [0.2 - 0.8]) respectively. CONCLUSION: Caretakers' newborn referral compliance was high in this setting. The newborn being sick, being born to a younger mother and a reminder visit by the CHW to a referred newborn were predictors of newborn referral compliance. Integration of CHWs into maternal and newborn care programs has the potential to increase care seeking for newborns, which may contribute to reduction of newborn mortality.
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- 2013
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22. High Compliance with Newborn Community-to-Facility Referral in Eastern Uganda:.An Opportunity to Improve Newborn Survival
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Nalwadda, Christine Kayemba, primary, Waiswa, Peter, additional, Kiguli, Juliet, additional, Namazzi, Gertrude, additional, Namutamba, Sarah, additional, Tomson, Göran, additional, Peterson, Stefan, additional, and Guwatudde, David, additional
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- 2013
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23. Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda.
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Namutamba, Sarah, Namazzi, Gertrude, Waiswa, Peter, Peterson, Stefan, Nakakeeto, Margaret, Nakibuuka, Victoria K., Byaruhanga, Romano N., Najjemba, Maria, Namusaabi, Ruth, Tagoola, Abner, Nakate, Grace, and Ajeani, Judith
- Subjects
- *
MEDICAL education , *CLINICAL competence , *HEALTH facilities , *PREMATURE infants , *MATERNAL health services , *ORGANIZATIONAL change , *POSTNATAL care , *QUALITY assurance , *RURAL conditions , *SELF-efficacy , *SUPERVISION of employees - Abstract
Background: In Uganda maternal and neonatal mortality remains high due to a number of factors, including poor quality of care at health facilities. Objective: This paper describes the experience of building capacity for maternal and newborn care at a district hospital and lower-level health facilities in eastern Uganda within the existing system parameters and a robust community outreach programme. Design: This health system strengthening study, part of the Uganda Newborn Study (UNEST), aimed to increase frontline health worker capacity through district-led training, support supervision, and mentoring at one district hospital and 19 lower-level facilities. A once-off supply of essential medicines and equipment was provided to address immediate critical gaps. Health workers were empowered to requisition subsequent supplies through use of district resources. Minimal infrastructure adjustments were provided. Quantitative data collection was done within routine process monitoring and qualitative data were collected during support supervision visits. We use the World Health Organization Health System Building Blocks to describe the process of district-led health facility strengthening. Results: Seventy two per cent of eligible health workers were trained. The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later. Health worker skills and competencies in care of high-risk babies improved following support supervision and mentoring. Health facility deliveries increased from 3,151 to 4,115 (a 30% increase) in 2 years. Of 547 preterm babies admitted to the newly introduced kangaroo mother care (KMC) unit, 85% were discharged alive to continue KMC at home. There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period. While equipment levels remained high after initial improvement efforts, maintaining supply of even the most basic medications was a challenge, with less than 40% of health facilities reporting no stock-outs. Conclusion: Health system strengthening for care at birth and the newborn period is possible even in low-resource settings and can be associated with improved utilisation and outcomes. Through a participatory process with wide engagement, training, and improvements to support supervision and logistics, health workers were able to change behaviours and practices for maternal and newborn care. Local solutions are needed to ensure sustainability of medical commodities. [ABSTRACT FROM AUTHOR]
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- 2015
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24. Engaging community health workers in maternal and newborn care in eastern Uganda.
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Kemigisa, Margaret, Okuga, Monica, Namutamba, Sarah, Namazzi, Gertrude, and Waiswa, Peter
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COMMUNITY health workers ,CONTENT analysis ,HEALTH education ,INTERVIEWING ,MATERNAL health services ,METROPOLITAN areas ,RURAL conditions ,SOCIAL networks ,PSYCHOLOGY - Abstract
Background: Community health workers (CHWs) have been employed in a number of low- and middle- income countries as part of primary health care strategies, but the packages vary across and even within countries. The experiences and motivations of a multipurpose CHW in providing maternal and newborn health have not been well described. Objective: This study examined the perceptions of community members and experiences of CHWs around promoting maternal and newborn care practices, and the self-identified factors that influence the performance of CHWs so as to inform future study design and programme implementation. Design: Data were collected using in-depth interviews with six local council leaders, ten health workers/CHW supervisors, and eight mothers. We conducted four focus group discussions with CHWs. Respondents included 14 urban and 18 rural CHWs. Key themes explored included the experience of CHWs according to their various roles, and the facilitators and barriers they encounter in their work particular to provision of maternal and newborn care. Qualitative data were analysed using manifest content analysis methods. Results: CHWs were highly appreciated in the community and seen as important contributors to maternal and newborn health at grassroots level. Factors that positively influence CHWs included being selected by and trained in the community; being trained in problem-solving skills; being deployed immediately after training with participation of local leaders; frequent supervision; and having a strengthened and responsive supply of services to which families can be referred. CHWs made use of social networks to identify pregnant and newly delivered women, and were able to target men and the wider family during health education activities. Intrinsic motivators (e.g. community appreciation and the prestige of being 'a doctor'), monetary (such as a small transport allowance), and material incentives (e.g. bicycles, bags) were also important to varying degrees. Conclusions: There is a continued role for CHWs in improving maternal and newborn care and linking families with health services. However, the process for building CHW programmes needs to be adapted to the local setting, including the process of training, deployment, supervision, and motivation within the context of a responsive and available health system. [ABSTRACT FROM AUTHOR]
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- 2015
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25. Community-made mobile videos as a mechanism for maternal, newborn and child health education in rural Uganda; a qualitative evaluation.
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Mutanda JN, Waiswa P, and Namutamba S
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- Child Health, Female, Humans, Infant Health, Maternal Health, Pregnancy, Qualitative Research, Uganda, Videotape Recording, Health Education methods, Health Knowledge, Attitudes, Practice, Postnatal Care methods, Prenatal Care methods, Rural Population
- Abstract
Introduction: In Uganda, the maternal, newborn and child mortality is highest in rural areas, which are least served by health services and are also least reached by effective behavior change communication for health. Though maternal and child health related messages are available, they are still not culture and context specific for effective behaviour change., Aim: This study aimed at evaluating the feasibility of using locally made videos by local community groups in local languages as a channel for increasing knowledge, practices, demand and use of maternal and child health messages among women living in rural communities in Eastern Uganda., Methods: This paper describes the qualitative findings from a quasi experimental study targeting the rural semi-illiterate populations in hard to reach areas. Videos were developed and implemented based on Ministry of Health. Focus group discussions and KIs targeted pregnant and post natal mothers. Data transcription and content analysis was done., Results: Local mobile community videos were effective in communicating knowledge about key maternal and child health messages to both women and their male partners., Conclusion: Locally made mobile community videos are effective in improving knowledge, attitudes, practices and use of maternal and child health messages among rural semi-illiterate communities.
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- 2016
- Full Text
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