Explore the vast range of titles available.

Whereas digital payments have been identified as a solution to health payment challenges, evidence on their adoptability among Community Health Workers (CHWs) is limited. Understanding their adoptability is crucial for sustainability. This study assessed the adoptability of digital payments for CHWs in Wakiso district, Uganda. A convergent parallel mixed-methods study was conducted between November and December 2022, in Wakiso district, Uganda. We surveyed a random sample of 150 CHWs using a structured questionnaire and conducted key informant interviews among three purposively selected Digital payment coordinators. The study utilized the Technology Acceptance Model (TAM) framework to assess the adoptability of digital payments among CHWs. Factor analysis was performed to extract composite variables from the original constituting variables. Using the median, the outcome was converted to a binary variable and logistic regression was conducted to assess the association between the TAM constructs and adoptability of digital payments by CHWs. Quantitative data was analyzed using STATA 14, while qualitative data was transcribed verbatim and analyzed using ATLAS.ti 22. Nearly all participants (98.0%; n = 49) had previously received payments through mobile money, a digital payment method. (52%; n = 78) of CHWs said they intend to use digital payment modalities. Perceived risk of digital payments was associated with 83% lower odds of adoptability of digital payment modalities (OR = 0.17;95%CI:0.052, 0.54), while perceived trust had nearly three times higher odds of adoptability of digital payment modalities (OR = 2.82;95%CI:1.41, 5.67). Qualitative interviews showed that most CHWs reported positive experiences with digital health payments, including effectiveness and completeness of payments except for delays associated with mobile money payments across payment providers. Mobile money was reported to be easy to use, in addition to fostering financial responsibility compared to cash. CHWs in Wakiso district intend to use digital payment modalities, particularly mobile money/e-cash. Perceived risk of the payment method and trust are key determinants of adoptability. Synergized efforts by both payment providers to manage payment delays and mitigate risks associated with digital payments could attenuate perceived risk and build trust in digital payment modalities.

Background Voluntary medical male circumcision (VMMC) remains one of the recommended HIV prevention measures in heterosexual men in selected countries, including Uganda. While most VMMCs are on adolescent and adult males, its longer-term potential population-level impact might be realized through the inclusion of early infant male circumcision (EIMC). However, EIMC’s successful rollout requires understanding the perspectives of health workers, health system-level facilitators, and barriers to EIMC. Following EIMC pilot/project implementation, we explored health workers’ individual-level perspectives on, and health system-level facilitators and barriers (to EIMC) in a traditionally non-circumcising setting in Northeastern Uganda. Methods In April 2022, we conducted a qualitative study involving 26 in-depth interviews. Participants included seven health workers who participated in EIMC and seven who did not, two heads of hospitals that conducted EIMC, and six District health officials, four representatives of national-level partners who supported EIMC implementation in the study area. Data were coded and analyzed using inductive (for individual-level perspectives) and deductive (for health system-level barriers and facilitators) thematic analyses. Results Health workers who had participated in EIMC reported its comparative advantages, including performance simplicity, faster wound healing, and relatively lower cost. Some health workers who had not participated in EIMC expressed concerns regarding the safety of the procedure and the potential associated pain. Health system-related facilitators for EIMC included leadership support and availability of funding and supplies for initial implementation and health workers’ capacity building through EIMC training. This support was limited to the project’s period and later ended. Therefore, barriers to EIMC implementation, including a lack of supplies and funding, were reported. Conclusion EIMC was perceived as a comparatively beneficial intervention for possible HIV prevention because, compared to VMMC, it is technically simpler, safer, potentially low-cost, and wound healing is faster. Nevertheless, some health workers raised concerns about EIMC. Leadership support, funding, health workers’ EIMC training, equipment, and supplies availability facilitated EIMC. Some facilitators were short-lived as a lack of continued funding and supplies stock-outs were major EIMC barriers. Successful implementation requires sustained EIMC financing and addressing the concerns of some health workers, in addition to the identified health system-related barriers.

Alcohol use is a major contributor to mortality and morbidity worldwide. Uganda has a high level of alcohol use per capita. Compared to men, women are less likely to consume alcohol globally; however, women who drink have increased risks for co-occurring conditions, including depression, intimate partner violence, and HIV. This study assessed the prevalence of alcohol use and correlates of harmful alcohol use by gender and HIV status in rural Uganda. We used cross-sectional data from a study among women and men aged 15-59 residing in rural, central Uganda and accepting home-based HIV testing (Nov 2017 to Dec 2020). We estimated the prevalence of levels of alcohol use (categorized as no alcohol use (score 0), low (score 1-3 for men; 1-2 for women), medium (score 4-5 for men; 3-5 for women), high (score 6-7), and very-high (score 8-12) use with the AUDIT-C), stratified by gender and HIV status. We assessed correlates of harmful alcohol use using multivariable logistic regression models for women and men. Among 18,460 participants, 67% (95% CI: 66-67%) reported no alcohol use, 16% (95% CI: 16-17%) reported low, 5% (95% CI: 4.8-5%) reported medium, 5% (95% CI: 4-5%) reported high, and 3% (95% CI: 2.8-3) reported very high alcohol use. Compared to women, men were more likely to report alcohol use (Chi-squared p-value<0.0001). People diagnosed with HIV (both newly diagnosed and previously aware of their status prior to home-based HIV testing) were more likely to report low, medium, high, and very high alcohol use compared to those who were HIV negative (Chi-squared p-value<0.0001). Among women, those who were newly diagnosed were more likely report alcohol use, compared to those who were HIV negative. In multivariable models, being newly diagnosed with HIV (compared to HIV negative) increased the odds of harmful alcohol use among women, but not men. While alcohol use was higher among men and people living with HIV, being newly diagnosed with HIV had a stronger relationship with harmful alcohol use among women than men. More research is needed to understand how alcohol use may increase the risks of HIV acquisition among women and to identify gender-responsive services to address harmful alcohol use and increase access to HIV testing and linkage to care for women who use harmful levels of alcohol.

Background Over 80% of morbidity due to soil-transmitted helminthiasis (STH) occurs in low-income countries. Children under 5 account for 20–30% of the burden in endemic areas. This study assessed the prevalence, intensity and factors associated with STH infections among preschool-age children (PSAC) in Hoima district, Uganda. The PSAC are particularly vulnerable because the chronicity of this condition usually affects their physical and mental growth and development. Methods A cross-sectional study was carried out among 562 PSAC (1–5 years old) in 6 counties of Hoima district using Expanded Program on Immunization (EPI) method. Stool samples from children were examined using the formol ether concentration technique for STH egg detection. Egg counts were represented as egg per gram (EPG). A structured questionnaire was used to collect information on factors associated with STH infection. Generalized linear models were used to analyze relationships between STH infection and associated factors. Results Overall STH prevalence was 26.5%. Hookworm infection was the most prevalent (18.5%), followed by A.lumbricoides (9.8%) and T.trichiura (0.5%). Prevalence of STH infection was significantly higher in children aged 5 years (Pearson chi-square test, p  = 0.009) than in children aged 1 year. The general geometric mean (GM) counts for Hookworm infection was (696.1 EPG; range (530.3–913.8)) with girls having a higher GM (789.8 EPG; range (120–13,200)) than boys. Eating uncooked or unwashed vegetables (adj. Prevalence Ratio (PR) = 1.9, 95% CI: 1.3–2.7) and fruits (adj.PR = 1.8, 95% CI: 1.1–2.8), indiscriminate disposal of young children’s faeces (adj.PR = 1.5, 95% CI: 1.1–2.0); not washing hands after defecation (adj.PR = 2.6, 95% CI: 1.9–3.6); and not deworming children regularly (adj.PR = 1.4, 95% CI: 1.1–1.8) were significantly associated with STH infection. Conclusion The prevalence of Soil transmitted helminths infection among preschool-age children in Hoima district significantly increased with age. Poor hygiene, inadequate sanitation and irregular deworming were associated with STH infections among PSAC in the study area. Intense health education on the importance of hygienic practices, improved sanitation and regular deworming of PSAC should be integrated into prevention and control programs.

There is inadequate evidence about the influence of digital and cash payment modalities on the performance of Community Health Workers (CHWs) in underserved communities, such as refugee settlements. To compare the performance of CHWs when paid in cash or digitally in Kyaka II refugee settlement, Uganda. A comparative cross-sectional mixed methods design was used. Secondary data comprising 247 CHW reports during a six-month period of cash and digital payments were analyzed using Stata v14. Eleven focus group discussions, four in-depth interviews, and ten key informant interviews were conducted among the settlement stakeholders to explore perceptions of the payment methods. Qualitative data were analyzed thematically using Atlas.ti v9. CHWs performed better when paid cash than digital payments (  = 5.28; df = 246;  < 0.001). During the cash payment period, at least secondary education (APR 1.71 CI: 1.14-2.58) and having a side occupation (APR 1.58; CI: 1.13-2.21) were positively associated with performance. For digital payments, being male (APR 0.58; CI: 0.34-0.98), serving longer than 9 years (APR 0.87; CI: 0.82-0.93), and being allocated more than 60 households per month (APR 0.31; CI: 0.19-0.52) were negatively associated with CHW performance. Qualitative data revealed that most stakeholders preferred cash due to inconsistent and delayed digital payments. CHWs preferred and performed better with cash payments because digital payments were associated with delays and payment shortfalls that demotivated them. Implementers should invest towards averting digital payment shortfalls in remote settings to enhance CHW motivation and performance.

BackgroundThe heightening of efforts to eradicate vaccine-preventable diseases through mass vaccination campaigns has contributed to a growing demand for effective and efficient payment mechanisms for frontline vaccination workers in large-scale campaigns. Subsequently, the Uganda Ministry of Health (MoH) adopted digital payments for campaign workers, which were either implemented by the government or partners. We specifically explored stakeholder perspectives on the feasibility of partner-implemented digital payment to front-line health workers in phase one of the yellow fever mass vaccination campaign in Uganda.MethodsWe employed a cross-sectional qualitative study. The study area comprised four districts (Amuru, Lira, Hoima and Kikuuba) purposively selected from 51 phase one yellow fever vaccination campaign districts. We collected data through 37 qualitative interviews (25 key informant interviews (KIIs) and 12 in-depth interviews (IDIs)). IDI participants included vaccination health workers (n=12). KII interview participants included district technical officials (n=14), representatives of digital payment implementing partners at district and national levels (n=7) and MoH staff (n=4). All interviews were audio-recorded and later transcribed and analysed using thematic analysis.ResultsThe partner-implemented payment system was linked with perceived improvements in timeliness and the increased likelihood of beneficiaries receiving complete payment. Despite these benefits, some payment delays were reported. These delays were mainly attributed to incomplete and inaccurate participant payment information. Health workers said they were more motivated because they felt assured of being paid and receiving the full amount.ConclusionsDespite drawbacks, partner-led digital payment of health workers was perceived as a feasible strategy promoting timely, complete payments. Relevant stakeholders should ensure accurate, complete and timely capture and verification of health workers’ payment details to counter payment delays. We recommend more rigorous evaluations to determine whether a partner-implementation of digital payment is more effective than government-led payment in different settings.

Objectives This study was set out to assess the level of adherence to antiretroviral therapy (ART) and its determinants among children receiving HIV treatment in Kabale district, south western Uganda, in order to inform interventions for improving pediatric ART adherence. Results Overall, 79% (121/153) of the children did not miss ART doses over the 7 days. Caregiver forgetfulness was the major reason for missing ART doses, 37% (13/35). Other reasons included transportation costs to the health facilities, 17%, (6/35) and children sitting for examinations in schools. Older children (11–14 years) were more likely to adhere to ART than the younger ones (0–10 years) (AOR = 6.41, 95% CI 1.31–31.42). Caregivers, who knew their HIV status, had their children more adherent to ART than the caregivers of unknown HIV status (AOR = 21.64: 95% CI 1.09–428.28). A significant proportion of children in two facilities 21.5% (32/153) missed ART doses within the previous week. Support for providers to identify clues or reminders to take drugs, extending HIV testing to caregivers and innovative models of ART delivery that alleviate transport costs to caregivers and allow sufficient drugs for children in school could enhance drug adherence among children.

BackgroundGender is a key factor shaping societal roles and access to resources, with cultural norms often limiting women’s abilities to use digital financial services. Despite the rise of digital payments, little is known about how gender relations influence their adoption and experience, especially among health workers involved in vaccination campaigns.MethodBetween January and September 2023, we explored how gender norms and relations influence the uptake and experiences of digital payments among health workers participating in mass polio vaccination campaigns. The qualitative study involved 23 focused group discussions (FGDs; 16 in Uganda and 7 in Malawi) and 82 in-depth interviews (IDIs; 35 in Uganda and 47 in Malawi) with healthcare workers who received digital payments for implementing polio mass vaccination campaigns. IDI participants included village health teams, midwives, nurses, health facility managers, immunisation focal persons and district health officers in Uganda, and community health workers, health facility managers and mobile money operators in Malawi. FGDs were held with midwives, nurses and village health teams in Uganda and community health workers in Malawi. Data were coded using Dedoose software and thematically analysed.ResultsParticipants highlighted that digital payments were convenient since they were able to receive funds without travelling long distances or queuing at health facilities. Women reported that it gave them more time to engage in alternative activities, improve their financial autonomy and ability to participate in decision-making around use of household funds. Structural challenges leading to delayed disbursement of funds were reported to reinforce gender norms around financial dependency on men to meet operational campaign costs (eg, transport). Reported limited ownership of mobile money accounts, a prerequisite for digital payments, led to the exclusion of some women.ConclusionOur findings suggest that digital payments could help improve financial autonomy and participation in decision-making around use of household funds among women involved in immunisation campaigns. However, our findings show that digital payments are implemented in the context of prevailing harmful gender norms that, if not addressed, have the potential to compromise women’s agency. This underscores the importance of integrating gender-transformative programming in planning for digital payments during vaccination campaigns.

ObjectivesThe present study aimed to identify the prevalence and correlates of depressive symptoms and potential intervention points among women and men from a population-based sample in rural central Uganda.DesignA cross-sectional study.SettingFour districts in rural Uganda.ParticipantsWomen and men aged 15–59 residing in four districts in rural Uganda accepting home-based HIV testing who completed a baseline survey at the time of testing.Primary outcome measuresDepressive symptoms measured by the 10-item Center for Epidemiological Studies Depression Scale using a cut-off score of 13 for significant depressive symptoms.ResultsAmong a sample of 9609 women and 6059 men, 1415 (14.7%) women and 727 (12.0%) men met criteria for significant depressive symptoms. Having ever received mental health services was associated with lower odds of significant depressive symptoms (women: adjusted OR (adjOR)=0.32, 95% CI=0.22 to 0.47; men: adjOR=0.36, 95% CI=0.18 to 0.62). Having received outpatient (women: adjOR=3.64, 95% CI=3.14 to 4.22; men: adjOR=3.37, 95% CI=2.78 to 4.07) or inpatient (women: adjOR=5.44, 95% CI=4.24 to 6.97; men: adjOR=3.42, 95% CI=2.21 to 5.28) care in the prior 6 months was associated with greater odds of significant depressive symptoms. For women only, known HIV positive status (adjOR=1.37, 95% CI=1.05 to 1.77), and for men only, alcohol misuse (adjOR=1.38, 95% CI=1.12 to 1.70), were associated with increased odds of significant depressive symptoms.ConclusionOur findings suggest that depression screening within outpatient and inpatient settings may help to identify people in need of mental health services. Routine screening in outpatient or inpatient clinics along with the implementation of evidence-based interventions could ultimately help close the mental health gap for depression in this and similar settings.

Background Indoor residual spraying (IRS) is an efficient method of preventing malaria in homes, and community willingness to take up IRS is critical to its success. The first phase of IRS was conducted in Tororo district, Uganda between December 2014 and January 2015. High coverage rates (90%) were attained in the district. However, Mulanda sub-county had the lowest coverage of 78%, in the first round. This study assessed willingness and associated factors of IRS uptake among household heads for the next IRS campaign in Mulanda sub-county, Tororo district. Methods A household survey was conducted in all three parishes of Mulanda sub-county. A multistage sampling technique involving the village and household as the first and second sampling levels, respectively, was used to identify 640 households Household heads were interviewed using standard questionnaire. Seven key informants were also conducted to explore the impact of community IRS-perceptions on uptake. Bi-variable and multi-variable logistic regression analyses were used to identify factors associated with willingness to take up IRS. Qualitative data was analysed by thematic content analysis method. Results Most (79.9%) respondents were willing to take up repeat IRS. However this was below the target of 85%. Fear of insecticide adverse effects (62%) was the most common reason mentioned by 134 (21%) household heads who were not willing to take up IRS. Factors associated with to take up IRS were; age ≥ 35 years (AOR 1.9; 95% CI 1.08–3.51), higher socio-economic status (AOR 0.4; 95% CI 0.27–0.98), not taking IRS in previous round (AOR 0.1; 95% CI 0.06–0.23), not knowing reason for conducting IRS (AOR 0.4; 95% CI 0.24–0.78) and having an iron sheet roof (AOR 2.2; 95% CI 1.03–4.73). Community and religious leaders were the preferred sources of IRS information. Conclusions The level of willingness to take up IRS was low (79%) compared to the targeted 85%. Involvement of community and religious leaders in community sensitization on the efficacy and safety of the chemicals could increase uptake of IRS.