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Mak Researchers Design National Drowning Prevention Strategy

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By Joseph Odoi

Makerere University researchers under Trauma, Injuries and Disability (TRIAD) Unit) have designed a national drowning prevention strategy. This strategy comes at a time when there is sky rocketing cases of drowning in Africa.

Globally, drowning is the third leading cause of unintentional injury death; accounting   for 7% of all injuries. Over 90% of the estimated 322,000 annual global drowning deaths occur in low-and middle-income countries.

Although the burden of drowning is believed to be highest in the WHO-African region, data collection and surveillance for drowning in African countries is limited.

In bid to contribute to data driven interventions, Makerere University researchers carried out a study aimed at establishing the availability of drowning data in district-level sources and understanding the reporting of and record keeping on drowning in Uganda.

As part of the study titled: Drowning in Uganda; examining data from administrative sources, researchers engaged various health stakeholders who shared their experiences about drowning and how it can be prevented in communities.

It is upon that background that scholars designed a contextual appropriate strategy for drowning prevention in Uganda under the project titled; Drowning in Uganda; examining data from administrative sources.

 According to the researchers, this drowning strategy is first ever in Uganda. ‘’it will be a national document that will guide all the efforts on drowning prevention in the country; and will avoid non-coordinated activities aimed at prevention of drowning. the strategy will also provide for monitoring and evaluation of all activities and interventions for drowning prevention in the country since there will be a government lead agency tasked with this responsibility’ ’explained Mr. Fredrick Oporia who is part of the study team 

STRATEGIES TO PREVENT DROWNING

In this study published on semantics scholar among other journals, the researchers came up with the following   strategies to counter drowning;

• Setting and enforcing safe boating regulations. • Providing incentives that encourage adherence to boating regulations related to not overloading transport boats and increasing enforcement of boating regulations. • Ensuring boats are fit for purpose and increasing regular inspection of the seaworthiness of boats. • Improving detection and dissemination of information about the weather. • Supporting increased availability and use of lifejackets through subsidy, lifejacket loaner programs, and free lifejacket distribution programs. • Increasing sensitization about safe boating practices, the importance of wearing lifejackets, and limiting alcohol and illicit drug use when boating. Community members, especially children, are vulnerable to drowning in unsafe water sources such as ditches, latrines, wells, and dams. Potential interventions could include: • Modifying access to wells and dams to prevent children or adults from falling in. • Installing boreholes and pumps to enable community members to draw water safely.

Providing safe rescue and resuscitation training to community members and conducting refresher trainings. • Developing and providing low-cost rescue equipment such as boat fenders (rubber and ropes tied to boat on all sides that can assist in the immediate rescue of individuals) and buoyant throwing aids.

To enable ongoing design, implementation, and evaluation of drowning prevention efforts, the researchers note that it is essential to collect data on drowning incidents. Reporting of and record keeping on drowning in Uganda should  also be  improve  according to the researchers  namely; Tessa Clemens, Frederick OporiaErin M Parker, Merissa, A Yellman,  Michael F Ballesteros and  Olive Kobusingye

Other Potential interventions highlighted by the researchers include: • Providing records officers with proper training, equipment, and appropriate storage facilities. • Sensitizing the public on the importance of reporting all drowning cases to authorities.

As part of their study findings, the researchers noted that; A total of 1435 fatal and non-fatal drowning cases were recorded; 1009 (70%) in lakeside districts and 426 (30%) in non-lakeside districts.

 Of 1292 fatal cases, 1041 (81%) were identified in only one source. After deduplication, 1283 (89% of recorded cases; 1160 fatal, 123 non-fatal) unique drowning cases remained. Data completeness varied by source and variable.

On demographics, fatal victims were predominantly male (85%), and the average age was 24 years. In lakeside districts, 81% of fatal cases with a known activity at the time of drowning involved boating.

What were people doing when they drowned?

 Activity at the time of drowning in lakeside districts and non-lakeside districts 

 • Overall, boating was by far the most common activity that people were engaged in at the time of the drowning incident.

 • Other common activities were collecting water/watering cattle and travelling on foot.

 • The most common activities that people engaged in prior to drowning were similar in lakeside and non-lakeside districts. However, in non-lakeside districts, more drowning deaths occurred as a result of collecting water or watering cattle than as a result of boating in those districts.

• Almost half (48%) of all drownings occurred while the person was engaged in an occupational activity.

Of the 1,063 people who died from boating-related drowning or suffered a severe boating related drowning incident but survived, 1,007 (95%) were not wearing a lifejacket at the time of the incident.

Key characteristics of drowning deaths in Kampala

Bathing in water bodies: Study participants indicated that drowning sometimes occurs when people are bathing in lakes, ponds, swamps, and valley dams. People can unexpectedly slip into deep water from shallower areas or rocks.

Crossing flooded rivers and streams:

 Attempting to cross flooded rivers and streams during the rainy season was another cause of drowning identified by study participants.

“Currently, people cross from makeshift bridges such as that of round poles. When the river overflows, it covers them. So, you can’t see them; so, you just start guessing: ‘the pole might be here or there’ and in case your guess is wrong, you automatically drown and you will be gone.” an Interview respondent in   Kabale district explained

Delayed rescue attempts: Study participants identified the importance of timely rescue and resuscitation to prevent death from drowning. However, they also indicated that community members lack knowledge on how to rescue someone who is drowning.

Alcohol use: Several participants identified alcohol use as a key risk factor for drowning. Participants stated that alcohol use is common, especially in fishing communities. “We have a problem with alcoholism. Many of our colleagues go to the waters when their minds are a bit twisted by the alcohol and on some occasions, this has caused accidents and some of them have drowned just like that.” – Interview respondent, Nakasongola district.

Photo of a child carrying water by the lakeside alone and a quote from a study participant

When asked on strategies of preventing drowning, participants suggested the following strategies for preventing drowning:

• Provide affordable and high-quality lifejackets to all water transport users and fishing communities. • Increase sensitization of fishermen and all water transport users on the importance of using lifejackets and avoiding alcohol while boating. • Provide subsidies for large and motorized boats that can be used for safe water travel and fishing to replace small and low-quality boats that are currently in use.

Inspect boats regularly to ensure they are in good travelling condition. • Recruit and deploy more marine police units on all major water bodies to enhance security and quick response to drowning incidents. • Install boat fenders (rubber and ropes tied to boat on all sides) to assist with the immediate rescue of individuals who are involved in a drowning incident. • Provide frequent and safe ferry services to enable water travellers access to safe transportation across rivers and lakes. • Avoid fishing during the moonlight periods to minimize hippopotamus attacks which are more frequent at that time.

 “I think these fishermen really need lifejackets for their work and also need to be sensitized on how to manage the engine of the boats that they use for their work. In most cases, these men just learn how to use these boats without having been trained first.” – Interview respondent, Rakai district. Swimming and basic rescue skills said

Moving forward, the researchers recommend that since; drowning is a multisectoral issue, and all stakeholders (local and national government, water transport, water sport, education, fishing, health, and law enforcement) should coordinate to develop a national water safety strategy and action plan.

MORE ABOUT THE STUDY

The study was conducted in 60 districts of Uganda for a period of 2.5 years (from January 1st, 2016 to June 30th, 2018). In the first phase, records concerning 1,435 drowning cases were found in the 60 study districts.

In the second phase, a total of 2,066 drowning cases were identified in 14 districts by community health workers and confirmed through individual interviews with witnesses/family members/friends and survivors of drowning. This work was funded by Bloomberg Philanthropies through the CDC Foundation

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Researchers call for interventions to support HIV/AIDS prevention among University Students

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Group photo of Study team and Participants at the Dissemination meeting.

Researchers at Makerere University College of Health Sciences have given recommendations on how the education and health sectors can support HIV/AIDS prevention among students.

The researchers advised that the health sector should develop communication strategies and materials specific to university students and increase support to provide youth-friendly HIV prevention services at universities. The education sector working with University management should include: life skill programs during orientation of new students; HIVST delivery through peers and freshman orientations; Increase sensitization & access to PEP/PrEP by high-risk students; and update and disseminate institutional HIV policies.

The recommendations were made at a dissemination meeting for a study titled ‘HIV risk and factors associated with use of novel prevention interventions among female students at Makerere Universityheld on the 30th September 2022 at the Food Science & Technology Hall, Makerere University Campus.The study funded by Government of Uganda through the Makerere University Research & Innovations Fund (MakRIF) was conducted by Dr. Lorraine Oriokot (Principal Investigator), Dr. Ivan Segawa, Dr. Sabrina Bakeera-Kitaka, Dr. Andrew Mujugira and Ms. Sharon Okello.

The objectives of the study were: to know the percentage of female students at risk of HIV; and to know the characteristics of students that have used the newer HIV prevention methods, which are HIV self-testing; Pre-exposure prophylaxis; and Post-exposure prophylaxis.

A total of 534 female students with an average age of 22years completed the survey. The results and findings of the study were:

  • Behavioural characteristics (12% of the respondents were in multiple sexual relationships; 21% of the respondents had a partner ≥ 10 years from their age; 29% of the respondents used emergency contraceptive (in the past 6 months); 21% of the respondents had never tested for HIV; and 10% of the respondents believed that they were at high risk for HIV)
  • The study considered a person was high risk if they: Had a partner who was HIV positive; Had multiple sexual relationships, anal or transactional sex; Used drugs especially injectable drugs; Had 2 or more sexually transmitted episodes in one year; Were pregnant or breast feeding; Were or had partners who sex workers, fishermen, long-distance truck driver, boda-boda rider, or army officers
  • Overall, 21% students were deemed high risk for HIV; 19% of students had ever used HIV self-test kits; 64% had ever heard of oral HIVST; 93% were willing to use HIVST; HIVST was more likely to be used by older students; HIVST can bridge the HIV testing gaps among students
  • 80% had ever tested for HIV far below the global targets of 95%; Self-test kits are freely available at the University Hospital; Test kits can be purchased over-the-counter in pharmacies
  • For PEP it was found that:3% of students had ever used PEP; 9% among those eligible for PEP; 70% had ever heard of PEP; 65% were willing to use PEP; PEP use was linked to having a partner and high-self risk perception; PEP is currently the only way to reduce the risk of HIV infection in an individual who has been exposed to HIV; PEP is available at Makerere University Hospital at no cost
  • For PreP it was found that:1% of students had ever used PrEP; 2% among high-risk students; 45% had ever heard of PrEP; 52% were willing to use PrEP; PrEP has been linked with decreased new infections of HIV; PreP is currently available as oral tablets. Vaginal rings and injectable forms are being tested for wide roll out; and PrEP is available at KCCA health facilities and facilities offering HIV care.

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Research findings show that Iron levels of blood donors in Uganda are low

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Members of the research team at the dissemination on 15th November 2022.

Makerere University researchers have released research findings showing that some blood donors in Uganda have low iron levels,low iron stores are common in blood donors, and that the donors who are deferred for low blood levels have limited insight into their situation. The findings were presented at a research dissemination workshop held on the 15th November 2022 at Makerere University College of Health Sciences.

In his remarks, Dr. Aggrey Dhabangi, Principal Investigator (PI) of the study explained that lack of iron may result in anaemia, which in turn makes blood donors ineligible to donate. ‘Other complications arising from low iron include, fatigue, low energy, and depression’, he added.

Statistics show that Uganda collects about 300,000 blood donations per year which is below the WHO recommended target of one donation per 100 population per year. As such, more donations are needed to increase blood supply. However, 10% of potential donors are turned away (deferred), 25% of these are due to low blood levels (anaemia); these missed donations may further exacerbate blood shortages in the country. Thresholds for eligibility to donate are 12.5g/dL and 13.5 g/dL for women and men respectively.

A total of 500 donors were involved in the cross-sectional study conducted within the central region blood collection sites of the Uganda Blood Transfusion Services (UBTS). The key findings of the study included:

  • The results showed that, of all potential donors screened to donate, 20.6 % had low iron stores. Among donors with blood levels acceptable to donate, 11.5% had low iron stores, while among those already turned away from donating for low blood levels, 61.5% also had had low iron.
  • The prevalence of low iron stores was higher among females (33.0%) compared to males (2.5%), but even higher among younger females i.e., 24 years and below (35.4%).
  • Further analysis revealed that, NOT eating an“iron-rich” diet was a major factor linked to low storesamong blood donors.
  • Interviews with donors turned away from donating for low blood levels revealed that many did not receive sufficient explanations as to why they were turned away, and what they were told was sometimes confusing to them.
  • Although the majority were surprised to be found with low blood levels and seemed frustrated for being turned away; deferral for low blood levels was generally poorly understood. Some interpreted it to mean, they had just ‘enough blood for themselves, but not enough to donate’. Others took the issue very lightly, yet their iron measurements have shown that 61.5% of these individuals besides being low on blood, they also had low iron.

The researchers gave the following recommendations:

  • Dietary (Iron-rich diet):Action – The population should be encouraged to adopt healthy eating lifestyle/diet which is iron-rich.Foods like leafy greens (bbugga, dodo, nakati), liver, beef, beans among others should be included in diets.
  • Behavioural change communicationon nutrition should be instituted to get the populations to change their diets and eating habits.
  • Consider Iron supplements for the population to repleteiron stores. The UBTS/Ministry of Health can offer iron pills to the affected donors. In the past this was done.
  • Identify donors at risk of Iron Deficiency through screening to identify affected persons early enough for interventions.
  • Improved communication is necessary for better handling of blood donors; the capacity of UBTS staff should be built; produce IEC materials for deferred donors: anaemia treatment, and prevention
  • Referral – to physicians for work-up and further management of anaemia

This study was made possible through collaboration between Makerere University College of Health Sciences and Uganda Blood Transfusion Services. Funding support was provided by the Government of the Republic of Uganda, through the Makerere University Research and Innovations Fund (Mak-RIF) – Round 3, financial year 2021/22.

Research Team: Dr. Aggrey Dhabangi (Principal Investigator (PI) and Co-PIs Dr. Godfrey Siu, Dr. Ronald Ssenyonga, Dr. Susan Acan, Mrs. Dorothy Kyeyune, and Dr. Imelda Bates.

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METS Newsletter October 2022

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Mabel from METS takes Biostatisticians through eCBSS during the DHIS2 training. Photo: MakSPH METS.

The Monitoring and Evaluation Technical Support (METS) Program is a 5-year CDC-supported collaboration of Makerere University School of Public Health (MakSPH), the University of California San Francisco (UCSF) and Health Information Systems Program (HISP Uganda).

Highlights of the METS August 2022 Newsletter

  • Advancing health information security, privacy and confidentially
    • With support from the Makerere University School of Public Health (MakSPH) – METS Program and other partners, the MoH has developed the national Health Information Exchange (HIE) and Interoperability guidelines that will guide the implementation of HIE initiatives within the health sector.
  • Inaugural HIV Recency Testing Data Quality Assessment
    • The inaugural HIV Recency Testing Data Quality Assessment (DQA) was conducted from 28th August – 10th September 2022, with an aim of designing interventions for improving data quality for public health action.
    • The DQA was carried out in a representative sample of 170 facilities geographically distributed across the country by 15 teams of members from MoH, METS, UCSF, implementing partners (IPs) and districts health teams.
  • Case Based Surveillance Learning Exchange in Kenya
    • The main objective of the learning visit was to benchmark the Kenyan CBS program with the aim of harnessing the implementation modalities, lessons learned, and best practices that will guide program improvements in Uganda.
    • The key lessons learnt for implementation of the CBS program in Uganda will require key steps including; strong leadership, coordination and involvement by MoH and partners, alignment of funding priorities with national needs; clear documentation of policies and guidelines; adoption of a unique identifier to manage de-duplication of patients across the health sector; strengthening communities of practice within the workforce capable of maintaining and extending the CBS implementation and development of a national data warehouse for surveillance.
  • Milestones in equipping health facilities to track commodities
    • UgandaEMR is an electronic medical records system that is currently in use in over 1,400 health facilities in Uganda. UgandaEMR currently supports the following service areas such as HIV, TB, MCH, Laboratory, SMC, and Cervical Cancer, among others. Since 2015, the MakSPH-METS program has been supporting the Ministry of Health in the design and development of UgandaEMR.
    • One of the latest modules added to UgandaEMR by MaKSPH-METS is the stock management and dispensing (SMD) module that supports the documentation of essential medical supplies distributed and/or received at health facilities from the national medical warehouses.

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