Background: Post cesarean surgical wound infection has been identified as a major problem among women of child bearing age. In developing countries, the rate at which post cesarean mothers get surgical wound infection is still high’(Oliver et al., 2009). In Uganda many mothers who deliver by cesarean section get surgical wound infection that led to increased morbidity, mortality, prolonged hospital stay and increased medical costs Objective: The aim of the study was to determine risk factor for post cesarean infection among mothers who had under gone cesarean section on ward 5B Mulago national referral hospital. Methods: This was a case control study that involved post cesarean mothers who were admitted at Mulago national referral hospital between August and October 2015. A total of 186 (93 cases and 93 control) post cesarean mothers were enrolled into the study. Post-operative data was collected using a standardized questionnaire. A data bases was designed for data entry and there after the data set was transported to SPPSS for analysis Results: Eight independent risk factors for post cesarean wound infection were identified in this study by multivariate analysis and these included; primary and tertiary level education (OR: 6.85, 95%CI:1.4-33.46, P =0.018 and OR: 22, 95%CI:4.57-108.6, P= 0.001 respectively), antenatal care attendance ( OR 0.02, 95%CI: 0.003-0.12 , P < 0.001), diabetic mothers ( OR: 0.004, 95%CI: 0.00-0.038, P < 0.001), pre-operative hemoglobin levels less than 7g/dl( OR: 0.12, 95%CI:, 0.03-0.497 P = 0.003) , Vertical type of skin incision( OR: 0.14, 95%CI: 0.03- 0.624, P = 0.010) , duration of labor greater than 12 hours ( OR:0.10, 95%CI:0.02-0.417, P = 0.002), senior surgeons performing the operation (OR: 47.78, 95% CI: 3.078-741.8, P =0.006 ) and spinal type of anesthesia.( OR:25, 95%CI: , 3.33-187.643 P =0.002) . Conclusion: Post cesarean wound infection was associated with multiple factors which included primary and tertiary levels of education, antenatal care attendance, diabetes mellitus, preoperative hemoglobin levels less than 7g/dl, vertical type of skin incision, duration of labor greater than 12hours, senior surgeons performing the operations and spinal type of anesthesia. The need to reduce post cesarean wound infection should currently receive considerable attention and requires more research in order to reduce unnecessary morbidity, mortality and associated socio- economic consequences for the patient and her family. Recommendations: Sensitization of the public on modifiable risk factors for post cesarean wound infection is need and senior surgeons need to perform surgeries more often than concentrating on administrative work.

The study was carried out basing on the topic “Hygiene practices of postpartum mothers in a rural Ugandan setting.” It aimed at establishing the Perineal care practices of postpartum mothers, establishing hand hygiene practices of post-partum mothers and assessing the knowledge of postpartum mothers on prevention of puerperal sepsis at Mubende Regional Referral Hospital. The study employed both quantitative and qualitative research designs where both questionnaires and interview guides were used to collect data from the field. All data was grouped and analyzed in a statistical way where by data was presented in tables showing frequencies and percentages. The following results were obtained basing on the study findings; The perineal care practices of postpartum mothers included; mothers bath 3 times a day, use lukewarm water to clean the perineal area, use local herbs to clean the perineal area, use soft facial tissues, sanitary pads and clean cotton cloths to pad themselves. The Hand hygiene practices of postpartum mothers included use of soap and water to wash their hands, obtained water for washing their hands from the nearby wells and also washed their hands by use of water and soap to kill germs. Also mothers had knowledge on how to prevent puerperal sepsis through maintaining hand hygiene practices, through use of clean delivery kits among others. The researcher recommends that; there is need for sensitization of the rural mothers on the causes and effects of puerperal sepsis, need for government intervention through placing required medicine in rural referral hospitals, training of the Traditional Birth attendants on the appropriate hand hygiene practice and allocation of enough funds on the national budget to build enough hospitals to cater for mothers in rural areas.

Background to the study Malaria is the leading cause of morbidity and mortality in Uganda and it is endemic in 95% parts of Uganda (PMI, 2009). According to ADHSD (2012), malaria accounted for 30% of all disease burdens in Amolatar district in 2009. Several trials carried out in the 1980s and 1990s showed that proper use of ITNs can reduce malaria cases by up to 50% and a reduction in deaths of children under 5 years by 20% (NSMC, 2001). In 2002, Uganda adopted a WHO recommended quality standard for ITNs and developed a national implementation strategy for ITNs in 2003. By June, 2008, over 5 million ITNs had been distributed to households with pregnant women and children less than 5 years in various parts of Uganda including Amolatar district (MOH, 2008). Despite all these efforts, the level of utilization of ITNs in Amolatar district has remained low bringing into question the knowledge, attitudes and practices of this community regarding use of ITNs. There is paucity of data on knowledge, attitudes and practices about use of ITNs in Amolatar district hence the purpose of the study. Purpose of the study The purpose of this study was to determine the knowledge, attitudes and practices regarding use of insecticide treated bed nets (ITNs) among residents of Namasale Landing Site in Amolatar District. Study objectives The specific objectives were to: - establish the level of knowledge regarding use of ITNs among residents of Namasale Landing Site in Amolatar district, determine the attitudes regarding use of ITNs among residents of Namasale Landing Site in Amolatar district and establish the practices regarding use of ITNs of residents of Namasale Landing Site in Amolatar district. Research methods A cross-sectional descriptive study design was used. The target population was residents of Namasale Landing Site who were at least 18 years of age. The data was collected through use of researcher administered questionnaires, observations and key informants interviews. The quantitative data were categorized and analyzed using STATA statistical software version 12 while qualitative data were manually summarized. Graphs and tables were used in the presentation of results and standard error and confidence intervals were used in the reporting of results. The research questions were addressed by estimating proportions and chi-square tests for independence to test any association between the dependent and independent variables. Key findings Most of the respondents (91.7%) said malaria was a problem at Namasale landing site and 77.7% of the respondents had ever heard about ITNs. The level of awareness about ITNs among the respondents was good with 78.6% of the respondents knowing that ITNs can be used to prevent malaria. There was a statistically significant association between knowledge of ITNs and use of ITNs with 95.6% of those whose family members were sleeping under ITNs having knowledge about ITNs (P=0.003). Seventy percent (70%) of the respondents were not willing to spend their money on ITNs and the main reason given for this decision was that ITNs were too expensive for them (72.7%). The study showed that 57% of those who slept under the ITNs the night before the survey were the respondents themselves with only 14% and 13.2% of children under five years and pregnant women sleeping under the ITNs respectively. Sharing of ITNs among family members is a common practice among residents of Namasale Landing Site with 76.3% of those using the ITNs sharing them. Recommendations The government and all relevant stakeholders in malaria control and prevention should embark on aggressive ITNs awareness creation in order to dispel the negative attitudes expressed by the respondents in this study including myths about side-effects of ITNs, increase knowledge about ITNs as well as discourage the negative practices by the respondents (such as frequent washing of ITNs, drying ITNs in the sunshine and infrequent use of ITNs) that compromise the effectiveness of ITNs.

The purpose of this study was to investigate the knowledge and attitude towards having Caesarean Section delivery among the Eritrean community leaving in Kampala, Lubaga division. The specific objectives of the study were: i) To establish the proportion of women who deliver by CS among Eritrean community in Kampala, Lubaga division, ii) To assess the level of knowledge regarding Caesarean Section delivery among Eritrean community in Kampala, Lubaga division and iii) To assess the attitude towards Caesarean Section delivery among Eritrean community in Kampala, Lubaga division. A cross sectional descriptive study design was carried out in Lubaga division on both men and women aged 18-50. Primary data was collected using researchers administered questionnaires, a total of 80 respondents were sampled using convenience sampling technique. For uni-variate analysis, data was run using frequencies and percentages, and the results presented in form of pie chart and tables. The results indicated that 35 (43.8%) women and wife’s of the men respondents had CS in their last delivery, almost eight in every ten of the respondents strongly disagreed that CS would be the preferred method of delivery although they had a good knowledge on the indications and recovery of CS. Based on these findings, the study recommends that health care workers should give a complete information on CS during the ANC and pregnancy so this will allow couples to make informed decision about the health of the mother during pregnancy and delivery through CS. And health workers should allow and encourage women to have normal deliveries and whenever indicated it should be done quickly to save both lives

Introduction and Background: Dual Family Planning is the correct and consistent use of two or more contraceptive methods that is condoms in conjunction with another method(s) by the HIV positive people to prevent transmission of infections and re-infections of HIV/STI and unwanted pregnancy. Northern Uganda has the highest HIV infection rate of 8.2% compared to a national average of 7.3% in 2011 (UDHS) and with very low utilization of family planning methods among the married people with no evidence regarding HIV positive couples utilizing dual FP. Objective- This study was conducted to assess factors influencing uptake of dual family planning methods among HIV positive couples in Awach health centre IV, Gulu district. Methods: A descriptive cross-sectional study was carried out using both qualitative and quantitative techniques to assess the client factors, community factors and institutional factors influencing the uptake of dual family planning methods. The investigator used structured questionnaires which were administered to 264 respondents attending ART clinic at Awach health centre IV. We carried out 7 key informant interviews to collect information from the ART Clinic staff and expert Clients using key informant guides. Quantitative data was analysed using SPSS soft ware version 16.0 and presented in form of tables, pie charts, graphs at univariate and bivariate levels. Qualitative data was analysed manually presented in verbatim quotations. The results: This study showed 70.45% of the respondents had heard about dual family planning while 27.55% have not heard, of the 70.45% clients, only 38.6% were practicing dual FP method while the rest of the clients were not using dual method and the most used Family Planning methods was condoms, followed by injectables 24.24% and the least being permanent method 3.79%. At bivariate analysis, the clients’ related factors that were significant are, age (P-value<0.000), sex (P-value<0.025), religion (P-value<0.030), duration with partner (P-value<0.000), number of children (P-value<0.044) and the desire to have children (P-value<0.000). Among the community factors the following significantly influenced the use of dual FP; those who had heard about dual FP (P-value<0.000), partners’ acceptance (P-value<0.000), method of FP used (P-value<0.000), duration of usage (P-value<0.000) and sources of information (P-value<0.000). The following institutional factors also influence the use of dual FP; distance to the facility (P-value<0.035), getting FP services from same place (P-value<0.006) and getting FP on return date (P-value<0.006). Conclusions: The low uptake of dual FP method by HIV positive couples was significantly influence by their age, sex, religion, the duration they spent with their partners, number of children they desired, the duration of FP usage, sources of information, method of FP used, distance from the facility, accessibility and the availability of the dual FP services. Recommendations: The health facility staff, the local leaders and the government should join hands to ensure that emphasis is put on the age of client, sex of client, religion, duration spent with the partner, number of children desired, partner’s acceptance, duration of FP usage, sources of information, methods of FP used, distance to the health facility, accessibility and availability of dual FP services in order to increase the uptake of dual FP services among the HIV positive couples in Awach ART Clinic.

Background: Tuberculosis(TB) remains a public health problem worldwide (WHO, 2017a). World Health Organization’s End TB Strategy advocates for early diagnosis of tuberculosis with a target of being able to detect over 90% of all new cases of TB by 2035 for ending TB disease (WHO, 2015). The Uganda’s Ministry of Health has put a lot of emphasis on early diagnosis and early initiation of treatment as well as ensuring that treatment for tuberculosis is available free of charge. Despite the ministry’s efforts, informal review of cases of pulmonary tuberculosis managed at Bundibugyo hospital in 2015 showed that about 2 in 5 cases were diagnosed late with the disease (Bundibugyo Hospital, 2016). Hence this study sought to assess factors affecting early diagnosis of pulmonary tuberculosis among adult patients who were undergoing treatment at Bundibugyo hospital from July to September 2017. Objectives: The study aimed to assess factors affecting early diagnosis of pulmonary tuberculosis(PTB) among adult patients who were on treatment at Bundibugyo hospital. Methods: This study adopted a cross sectional analytical study design. The study was carried out at Bundibugyo hospital. Consecutive sampling was used to select 152 patients with PTB who participated in this study. Only primary data were collected using questionnaire. The questionnaires had both open and closed ended questions. The questionnaires were pre-tested and adjusted before data collections. Data analyses were done using SPSS software. Results: Only 3 (2%) of the 152 patients managed at Bundibugyo hospital for pulmonary tuberculosis were diagnosed with the disease early. Most patients (98%) had delayed diagnosis of pulmonary tuberculosis. Age of patients (X2= 17.723, P= 0.001) and their marital status (X2= 13.365, P= 0.010) were the only socio-demographic factors associated with diagnosis of pulmonary tuberculosis. Visiting a private clinic (X2= 5.101, P= 0.024) before treatment was the only personal factor associated with early diagnosis of pulmonary tuberculosis. Conclusions: The proportion of patients who were diagnosed early with pulmonary tuberculosis in Bundibugyo hospital was found to be very low. Age of patients and their marital status were the only socio-demographic factors associated with diagnosis of pulmonary tuberculosis. A patient visiting a private clinic for first consultations was the only personal factor associated with early diagnosis of pulmonary tuberculosis. Recommendations: The unit should intensify health education about early diagnosis of tuberculosis in all out-patients points of care within the hospital. The hospital should ensure that all its care providers are actively involved in sensitizing patients under their care about need for early diagnosis and treatment in case of infection with pulmonary tuberculosis. The Ministry of Health should also strengthen the public private partnership for health to improve early diagnosis of pulmonary tuberculosis since this study has shown that visiting private clinics first is associated with delayed diagnosis of pulmonary tuberculosis.

Although nurses prevent and control infections they lack the necessary knowledge to practice infection prevention and control. There is low compliance to infection control precautions including hand hygiene, the use of gloves and sharps management as a result of limited knowledge, poor staff attitude towards infection control measures leading to prolonged stay of the patients in the hospital, functional disability or reduced quality of life, high resistance to antimicrobial agents, emotional stress, additional financial costs for both the patients and their families and finally unnecessary deaths. This infections are actually preventable. It was essential to explore the knowledge, attitude and practices of nurses toward their prevention. Objective: The purpose of the study was to determine the knowledge, attitude and practices of the nurses on prevention and control of Hospital acquired infections in Soroti Regional Referral Hospital. Methodology: This study was a descriptive, cross-sectional study which employed simple random sampling method and a semi structured questionnaire was used to collect data from nurses in Soroti regional referral hospital. The sample size of 88 participants was used. Data was analyzed and tables, graphs, pie charts and percentages were generated. Study findings: The findings of the study revealed that 65.9% of the respondents were female while 34.1% were male. The diploma nurses constituted 48.9%, enrolled 29.5% and 21.6% of the respondents were graduates with degree award. Greater percentage of the respondents were diploma holder. Modal age group is 21-29 (48.9%, majority the respondents had experience of 1-5 years (58%). 51.1% of the respondents were very knowledgeable about hospital acquired infections, 37.5% of the respondents were quite knowledgeable about Hospital acquired infections. 81.8% of the respondents strongly agreed that every patient should be treated as if they carry blood borne. On the same note, 83.0% of the respondents said they always observe the infection control practices 90.9% of the respondents stated that they don’t recap needles after use. 96.6% of the respondents said they place disposable sharps in safety box immediately after use. Results also indicate that, 96.6% of the respondents always use gloves when doing procedure while 3.2% of the respondents sometimes use gloves when doing procedure. Conclusions. The respondents are more knowledgeable, having a positive attitudes towards but with low level of practices on prevention and control of hospital acquired infections. Recommendations. Health facilities should provide every nurse with guidelines on infection control measures, and should strictly supervise the nurses to ensure compliance. Health facilities should provide adequate disposal material to the nurses. Nurses should be given opportunities to upgrade and males also need to be encouraged to offer nursing course.

Introduction: Drug shops increase access to essential medicine, fill the gap left by the government health care facilities and they remain the most preferred source of medicine. But there are regulations that stipulate the conditions under which drug shops must operate if they are to promote the health of the public , unfortunately there are wide spread noncompliance with these regulations and therefore I set out to assess the drug shop compliance with licensing and inspection regulations in regulating drug shop practices in Lango Sub region. Methodology: The study was a survey that targeted at all the drug hops in Lango sub region and a census of 298 drug shops conducted in the randomly sampled districts of Amolatar, Alebtong, Lira, Kole and Lira municipality between 20th November and 19th December 2013. Researcher administered questionnaires were administered to drug shop operators, inspections of drug shops done using inspection checklist and in depth interview was done to three NDA staffs using the interview guide. Results: Findings have shown that, most (74.4%) drug shops were located in trading centers and half (50.3%) of these drug shops were being operated by employees. Across all the districts, only 30.9% of drug shops had valid operation permits. Only 8.4% of the drug shop operators across the districts were being operated by qualified personnel and all of them were enrolled nurses. No drug shop was found selling only class C drugs as prescribed in the regulation, but other services which were being offered includes laboratory services; sale of class A and B drugs, offering surgical and clinical services; and no drug shop was following good dispensing practices. Although 30.9% of drug shops had certificates of suitability of premises, no drug shop met all the criteria of suitability of premises in the study. Awareness of licensing and inspection regulations, presence of regulatory documents, inspections and sanctions were the factors influencing compliance to licensing and inspection regulations by drug shop operators. Inadequate resources were the main factor hampering enforcement of these regulations by NDA. Binary logistic regression analysis revealed by the wald statistic that regulation of persons (w=3.106) highly determines drug shops’ compliance to licensing and inspection regulations compared to regulation of practices (0.246) and regulation of premises (0.13). More so independence T-test revealed that awareness of regulations (t=-4.869, p<0.05), presence of regulatory documents (t=2.471, p<0.05), the frequency of drug shop inspection (t=9.966, p<0.05), sanctions imposed on drug shops (t=-2.01, p<0.05) significantly influence drug shops’ compliance to licensing and inspection regulations. Conclusion: Drug shops were not complying with licensing and inspection regulations due to inadequate enforcement of regulations and regulations that only allow the sale of class C drugs in Drug shops. Recommendations: NDA should revise regulations to include essential drugs in the class C group and provision other services; creating a provision in the regulation that involves local leaders, civil society organizations and consumers in the implementation of these regulations; and organizing them in to groups/associations to improve on the enforcement of these policies. The Government of Uganda should invest in training more health workers to ensure that qualified people operate the drug shops and consider giving soft loans and incentives to registered drugshop operators to improve on drug shop services and ppremises. Scholars/Researchers, Health Institutions and NDA should conduct further research on the areas and scope of involvement of local leaders, civil society organizations and consumers in the implementation of the policy.

This study was to cost the health services provided by Nyenga Hospital in the FY 2012/2013. The main objective of the study was to establish the average cost of providing a unit output of a service in Nyenga hospital and the specific objectives were to: i. To determine the total cost of providing services for the financial year 2012/13 ii. To determine the average cost per unit output for the financial year 2012/2013 iii. To determine the average cost recovery per cost service charged in the FY 2012/13. The study was a retrospective descriptive costs analysis study using a step down costing methodology (Shepard 1998). The cost of providing health services in Nyenga in the financial year 2012/2013 was determined using relevant data from 1st July 2012 to 30th June 2013. The study therefore recommends; i. The hospital should use this information to justify need for more financing other than user fees to government and other development partners. ii. The facility should adopt a flat rate for all services in OPD as this will enhance certainty and hence utilization iii. Since the theatre is underutilized the facility should consider revising the charges downwards and benefit from increased utilization and economies of scale and consider employing a surgeon. iv. Efficiency gain measures in terms of medicines selection and prescriptions should be implemented in attempt to reduce costs. v. Government should increase support to the facility if it has to remain providing quality services at a low cost Further studies should be done to cost other related levels of care to be able to make comparisons.

This research topic of study was to establish the factors influencing work burnout among nurses on medical surgical wards. A case study at Mulago National Referal Hospital. The main objective of this study was to determine the factors influencing work burnout among nurses at Mulago National Referal Hospital during the month of July 2015. The study population comprised of nurses working on medical and surgical wards at Mulago National Referal Hospital. The study design was a descriptive cross sectional study involving qualitative and quantitative methods of data collection. Data was collected using pretested self administered questionnaires distributed to 353 respondents. The research established that 314(89%) of the nurses involved in the sample population reperted to experience work burnout in the course of their duties at the health facility. Only 39(11%) reported not to haveexperienced work burnout during this study. Both studies indicated that the majority of the proportion of nurses involved in this study experienced work burnout.