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Mukono RDC Commends Mak on Empowering VHTs; Calls on Parliament to Appropriate Resources to Motivate them

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Hajat Fatuma Ndisaba Nabitaka, the Resident District Commissioner for Mukono district has appealed to Ugandan legislators to support efforts of community health workers (CHWs)/VHTs through appropriating some remuneration for them.

Hajat Nabitaka said she has moved the entire Mukono District during the COVID-19 pandemic period and throughout the taskforces and has since appreciated the great role played by CHWs.

“We thank you so much, you are the frontline soldiers. Because you do sensitize our people in the communities and you are always there throughout. If those in parliament could know what you do, they would speak passionately for you to receive some kind of salary,” said Hajat Nabitaka.

She was speaking at a dissemination workshop for Makerere University School of Public Health’s Cardiovascular Disease prevention program under the SPICES project held on December 8th 2021 at Colline Hotel in Mukono district.

“Sincerely speaking, we have many people who receive a lot of money, yet their out-put is minimal as compared to the work done by VHTs. I am appealing to the Commissioner [NCDs], researchers to advocate for renumeration for VHTs. I think this catchment area of the VHTs is the best. They are the ones who can solve some of the social problems affecting majority of families. Kindly think about the VHTs, keep up training the VHTs and speak for them,” she added.

Hajat Fatuma Ndisaba Nabitaka, the Resident District Commissioner for Mukono district
Hajat Fatuma Ndisaba Nabitaka, the Resident District Commissioner for Mukono district.

 Dr. Gerald Mutungi, assistant Commissioner Health Services- Non-Communicable Diseases (NCDs) department at the Ministry of Health says currently, the VHTs are working under non-monetary motivation scheme.

“They have been working and we are discussing their small allowance in the Ministry. The problem is that the numbers are so big. Even when you give them small allowances the budget becomes so big,” Dr. Mutungi observes.

Dr. Gerald Mutungi, assistant Commissioner Health Services- Non-Communicable Diseases (NCDs) department at the Ministry of Health
Dr. Gerald Mutungi, assistant Commissioner Health Services- Non-Communicable Diseases (NCDs) department at the Ministry of Health

He further advances that; “But to tell you the truth, the discussion is in the Ministry. I don’t know how it will end but this adds on the evidence that they are so useful and that they need to be motivated.”

The SPICES project Principal Investigator Dr. Geofrey Musinguzi says the study has proven  that if well trained, community health workers (CHWs/VHTs) have potential to deliver messages on prevention and control of cardiovascular diseases as well as enhance awareness amongst the various risk factors that raise cardiovascular diseases.

Through VHTs, the SPICES project reached a total of 10,936 people in households in 80 randomly selected villages in Mukono and Buikwe. Dr. Musinguzi contends that, trained VHTs that are trusted in communities are a gateway to increased community knowledge about CVDs and participation.

SPICES project Principal Investigator Dr. Geofrey Musinguzi
SPICES project Principal Investigator Dr. Geofrey Musinguzi

“As you observed, out of the many people the y [VHTs] visited, only 1% rejected them in their households. So, 99% were receiving them. So, to us we really think that is one resource that is available. If supported, they can actually deliver more in prevention of cardiovascular diseases,” said Dr. Musinguzi.

Under community intervention model of the SPICES project, Dr. Musinguzi notes that the key enablers of implementing the program is the availability of committed and motivated VHTs, receptive communities, supporting local and religious leaders as well as social gatherings and infrastructure like SACCOs, worship places, local infrastructure such as radios, public address system for health education.

Despite the unprecedented times brought by COVID-19 community health workers with support from SPICES project reached out a number of households in the project area in respect to CVDs. The project sensitized and empowered community health workers and health workers on COVID-19 prevention and subsequently equipped with tools such as facemasks, sanitizers, temperature monitors and standard operating procedures.

“Community Health Workers are largely motivated and over two years working with them, we have actually seen them do a lot of work, deliver these interventions. They have also reached quite a number of people in the households. COVID was a problem in reaching out those places but amidst that challenge, we moved to the community members,” contends Dr. Musinguzi.

Sarah Nalweyiso, a Village Health Team Member in Buikwe District says they (community health workers) received training in September 2020 under the SPICES project on how to continue with the work amidst the pandemic challenges.

“We received gumboots, notebooks, pens, sanitizers and masks,” says Nalweyiso.

 The SPICES project Principal Investigator Dr. Geofrey Musinguzi alongside  Dr. Gerald Mutungi, assistant Commissioner Health Services- Non-Communicable Diseases (NCDs) department at the Ministry of Health hands certificates to Community Health Workers at a dissemination workshop held on December 8th 2021 at Colline Hotel in Mukono district.
 The SPICES project Principal Investigator Dr. Geofrey Musinguzi alongside  Dr. Gerald Mutungi, assistant Commissioner Health Services- Non-Communicable Diseases (NCDs) department at the Ministry of Health hands certificates to Community Health Workers at a dissemination workshop held on December 8th 2021 at Colline Hotel in Mukono district.

She adds that they trained community members about behavior change and highlighting dangers of excessive consumption of alcohol, benefits of exercising, reducing consumption of cooking oils as well as eating fruits and vegetables.

“When we finished the training, we came back to our villages and started examining people using the risk factor assessment tools to evaluate the risk of cardiovascular disease.”

Esther Namaganda, another VHT member from Buikwe district says; “We moved around our communities mainly to screen the members for risk factors of cardiovascular diseases.”

The poor health seeking behavior was one of the highlighted contributors to delayed presentation to health facilities with cardiovascular diseases.

Dr. Isaac Ssinabulya, Cardiologist at the Uganda Heart Institute -UHI thanked SPICES Project on the great work it has done.

“We conducted research, myself and Dr. Mutungi on non-communicable diseases and established that the highest percentage of the most affected people are in communities, nearly 60%. We only see fewer people in hospitals,” Dr. Ssinabulya.

He adds that there are many people who flock UHI from farther places in this country coming for treatment and end up spending a lot of money, yet the diseases can be prevented.

Dr. Ssinabulya hailed the Community Health Workers for their support in ensuring people are empowered and are able to be screened early enough in order to mitigate the risks associated to advanced treatment of CVDs which include high cost of treatment as well as loss of life.

Pressure is one of the highly prevalent diseases in Mukono and Buikwe at 24%. “This high number requires to ensure that whoever visits our health facilities is screened and are counseled towards keeping healthy lifestyles. Let us work together to reduce the queues of people coming for treatment,” says Dr. Ssinabulya.

Dr Josephine Birungi, a Senior Research Scientist based at Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) in Entebbe underscored the role of VHTs and noted that their work and contribution can be sustained through continuous engagement and training.

 Dr Josephine Birungi Research Scientist based at Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and Dr. Isaac Ssinabulya, Cardiologist at the Uganda Heart Institute -UHI
 Dr Josephine Birungi Research Scientist based at Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and Dr. Isaac Ssinabulya, Cardiologist at the Uganda Heart Institute -UHI

She commended the VHTs on the good work. “We need to deploy family-centered-approach to educate the masses about these challenges such as NCDs. It will help efforts by SPICES project to continue. For instance if I knew my husband has diabetes, I will not put a lot of salt in food. But if I don’t know, we shall not make a change.”

She tipped both health workers and the Ministry of Health on continuous capacity building as well as sensitization of the masses.

“We need to sensitize the masses. We should reciprocate the attention we give to HIV/AIDs to NCDs. I appeal to all of you to support sensitization of our communities not only about heart diseases but also on other diseases such as HIV/AIDs among others,” Dr. Birungi.

Article originally published on MakSPH website.

Health

METS Newsletter March 2024

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A team documenting the background and other governance structure requirements in the EMR Implementation Guidelines during the stakeholder workshop held from 26th February to 1st March 2024. Makerere University School of Public Health (MakSPH), METS Program, Kampala Uganda, East Africa.

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 March 2024 Newsletter

  • Development of National Electronic Medical Records (EMR) Implementation Guidelines
    • To date, multiple Electronic Medical Records (EMR) systems have been rolled out to health facilities without implementation guidelines to inform the standard EMR process/clinical workflows within a typical health facility, minimum requirements for various EMRs to integrate and exchange patient information, insurance and billing workflows, human resources management, among others.
    • METS Program and USAID/SITES organized a five-day stakeholder workshop on 26th February to 1st March 2024, to develop and validate the EMR Implementation Guidelines for Uganda.
  • Improving the Quality of Voluntary Medical Male Circumcision
    • In February 2024, the METS Program, in collaboration with the Ministry of Health (MoH), Centers for Disease Control and Prevention (CDC), and Implementing Partners (IMs), conducted targeted onsite mentorship across 56 safe male circumcision sites in CDC-supported regions of Uganda.
    • Key findings highlighted the overall facility performance score of 78%, with 5 out of 8 thematic areas scoring above 80%. Notably, 99% of circumcised males had received Tetanus vaccines.
  • Innovation To Strengthen National Health Care Quality Improvement
    • The 10th National Health Care Quality Improvement (QI) conference brought together health service providers from various parts of the country to share experiences and what they are doing to improve service delivery to patients.
    • The Minister of Health, Hon. Dr. Jane Ruth Aceng, called for solutions that will provide answers especially in areas of governance and leadership, health workforce, information systems, service delivery, financing, special groups, and health products.
    • METS made a presentation on improved service delivery models focusing on empowering young women to stay HIV-free with the help of the Determined Resilient Empowered AIDS-free Mentored and Safe (DREAMS) initiative.
  • Gallery
    • Makerere University School of Public Health (MakSPH) launches state-of-the-art auditorium
    • Deploying latest EMR Version at Hoima RRH
    • Training of KCCA staff on use of Point of Care (POC) EMR
    • Stakeholder Workshop on Development of EMR Implementation Guidelines

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New Study Reveals Breastfeeding Mothers Embrace Nutrient-Rich Dish for Health Benefits

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Climbing beans on stakes in one of the gardens visited during the Efd-Mak Kabale District Sensitization in November 2021. Makerere University, Kampala Uganda, East Africa.

A study whose results were recently published in Food Science Nutrition, a peer-reviewed journal for rapid dissemination of research in all areas of food science and nutrition has revealed that there is a growing preference for wholesome meals, highlighting its numerous health benefits.

Titled; Lactating mothers’ perceptions and sensory acceptability of a provitamin A carotenoid–iron-rich composite dish prepared from iron-biofortified common bean and orange-fleshed sweet potato in rural western Uganda,” this study was conducted among pregnant and breastfeeding mothers seeking care at Bwera General Hospital, in Kasese district, western Uganda, between 4th and 15th of August 2023.

Researchers in a 2019 study published in BMC Pregnancy and Childbirth among pregnant and breastfeeding women in Northwest Ethiopia discovered that pregnant and breastfeeding women bear the highest burden of this deficiency due to heightened physiological demands for iron and vitamin A. These demands increase significantly during pregnancy to meet fetal needs and continue during lactation to support breastfeeding.

The 2020 report on Developments in Nutrition among 204 countries and territories for 30 years since 1990 highlights the substantial impact of dietary iron deficiency and vitamin A deficiency on women of reproductive age in low- and middle-income countries across Africa and Asia. These micronutrient deficiencies are of paramount concern in public health nutrition due to their adverse effects.

A 2022 study published in The Lancet Global Health reveals that progress in addressing anemia among women of reproductive age (15–49 years) is inadequate to achieve the World Health Assembly’s global nutrition target of reducing anemia prevalence by 50% by 2030 in low- and middle-income countries, including Uganda.

Breastfeeding mothers require a higher intake of iron, ranging from 10–30 mg/day, compared to 8 mg/day for adult males. To help meet this increased need, the World Health Organization (WHO) recommends iron supplementation programs during the postpartum period, starting immediately after delivery and continuing for the first 6 weeks.

On the other hand, the WHO advises against vitamin A supplementation during the postpartum period, as it offers no noticeable health benefits to either the mother or the infant. Instead, it encourages breastfeeding mothers to maintain a diversified diet that includes vitamin A-rich foods. However, it’s important to highlight that supplementing with vitamin A and iron during this time could enhance the content of these nutrients in breast milk.

In rural Uganda, breastfeeding mothers often face deficiencies in vital nutrients particularly vitamin A and iron. This is as a result of over reliance on plant-based local foods, like sweet potato and non-iron biofortified common bean like Nambale, which lack sufficient amounts of provitamin A and iron, respectively.

To improve vitamin A and iron intake among breastfeeding mothers, Uganda’s government, in collaboration with HarvestPlus, a global program dedicated to ending hunger through providing nutrient-rich foods launched biofortification programs. These initiatives introduced orange-fleshed sweet potato rich in provitamin A and iron-biofortified common bean as staple food in Uganda.

As part of his postdoctoral study, Dr. Edward Buzigi, a Nutritionist and Food security expert, at University of Kwa-Zulu Natal, South Africa, evaluated the perceptions and sensory acceptability of a dish made from a combination of orange-fleshed sweet potato and iron-biofortified common bean, known for their high levels of provitamin A carotenoids and iron.

The aim was to determine whether the test food could replace the traditional white-fleshed sweet potato and non-iron biofortified common beans, which lacks these essential nutrients.

Ninety-four breastfeeding mothers took part in the study comparing two foods. Participants assessed the taste, color, aroma, texture, and overall acceptability of both the test and control foods using a five-point scale. Ratings ranged from “dislike very much” to “like very much,” with attributes deemed acceptable if participants rated them as “like” or “like very much.”

Also, focus group discussions were held to explore participants’ thoughts on future consumption of the test food alongside statistical analysis done using the chi-square test to compare sensory attributes between the two food options, while the qualitative data from focus group discussions were analyzed using thematic analysis.

Findings revealed that taste, color, and aroma were satisfactory to the mothers and showed no significant difference between test food and control food. Mothers had favorable views of the taste, aroma, and color of orange-fleshed sweet potato and iron-biofortified common bean but expressed concerns about the soft texture of orange-fleshed sweet potato. Despite this, breastfeeding mothers expressed positive attitudes towards consuming orange-fleshed sweet potato and iron-biofortified common bean, as long as it was accessible, affordable, and easy to prepare.

Dr. Buzigi lecturers at the Department of Community Health and Behavioural Sciences at Makerere University School of Public Health in Uganda.

Read the scientific article here;  https://onlinelibrary.wiley.com/doi/full/10.1002/fsn3.4053

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Call for Applications: AWE Change Masters fellowship programme support

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L-R: The Departments of Family Medicine (School of Medicine) and Human Anatomy (School of Biomedical Sciences) Buildings, College of Health Sciences (CHS), Mulago Hill, Makerere University, Kampala Uganda, East Africa.

Makerere University College of Health Sciences in collaboration with Duke University, USA are conducting a national collaborative research study on Epilepsy with local leading researchers in the fields of neurology and psychology in Uganda and international experts in the field of neurology and neurosurgery in the USA. The study aims to investigate the panorama of epilepsy in Uganda across the life span by clinically characterizing its features, comorbidities, and risk factors among the general population, with a focus on stigma among adolescents.

Applications are invited for the AWE Change Masters fellowship programme support from postgraduate students of:

  • Makerere University College of Health Sciences
  • Mbarara University of Science and Technology
  • Gulu University

The closing date for the receipt of applications is 22nd May 2024.

Submit all Enquiries and Applications to awechangeproject@gmail.com

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