User fees; health staff incentives; and service utilization in Kabarole District; Uganda

The Objectives of this study are: To determine the impact of user fees on the utilization of health services in a community-based cost-sharing scheme in Kabarole District; Western Uganda. Methods: Of the 38 government health units that had introduced user-fee financing schemes; 11 were included in the study. Outpatient utilization was assessed as the median number of visits per month before and after cost sharing began. Findings: After the introduction of cost sharing; overall utilization of general outpatient services; assessed by combining the data from all the participating units; dropped by 21.3. Utilization increased; however; in facilities located in remote areas; while it decreased in those located in urban or semi-urban areas. The increased utilization in remote facilities was considered to be largely attributable to health workers' incentives payments derived from cost-sharing revenues. Conclusions: Incentive payments led the health workers to offer improved services. Other factors may also have been influential; such as an improved drug supply to health facilities and increased public identification with community projects in remote areas

In Vivo Sensitivity of Plasmodium Falciparum to Chloroquine; Amodiaquine and Sulfadoxine-pyrimethamine in Western Uganda

In an in vivo study of antimalarial sensitivity in kabarole district; Western Uganda; 82of asymptomatic malarial infections and 86of symptomatic infections were chloroquine sensitive. Of persons with symptomatic malaria; 88were sensitive to sulfadoxine-pyrimethamine (Fansidar). Amodiaquine cleared parasites in all persons in whom it was used. Over the course of the past five years; there appears to be no substantial increase in the extent of chloroquine resistance in Western Uganda. Source: Trop.Geogr.Med. 1994; 46(6):364-5

The prevalence of epilepsy follows the distribution of onchocerciasis in a Western Uganda focus

Epidemiological surveys indicate that the prevalence of epilepsy is higher in developing countries than in industrialized countries. Except for neurocystocercosis due to Taenia solium; little is known about possible underlying causes. This article reports the relationship between epilepsy and onchocerciasis in an Onchocerca volvulus endemic area in West Uganda. Individuals complaining of seizures were identified by means of apopulation census in 12 villages. Active epilepsy was confirmed in 61 of 4743 inhabitants (crude prevalence rate = 1.3 ; age-standardized rate = 1.1 ). Distribution of epilepsy in the study area was clustered; ranging from a prevalence of 0.2 to 3.4 in difference villages. Age-specific prevalence was highest between 10 and 19 years; with a rate of 3.6 for the study are as a whole; and up to 10.0 in villages of high epilepsy prevalence. The prevalence of onchocerciasis in the 10-19 -year-old age group was assessed by skin-snip biospy and ranged from 15 to 85 in different villages. Epilepsy was significantlymore frequently more frequent in the three villages with the highest levels of O. volvulus emdemicity than in other villages (P0.0001). Serological testing for T. solium infection was positive in one and borderline in three of 53 epilepsy patients tested. The significant correlation between epilepsy and Onchcerciais did not change when these four patients were excluded from the analysis. These findings suggest a strong association between epilepsy and onchocerciasis in this area. This could have significant implications for the concept of morbidity due to O.volvulus

Onchocerciasis prevalence in previously known foci in western Uganda: results from a preliminary survey in Kabarole district

A prevalence survey of onchoceriasis was done in Kabarole district; Uganda; in 1990. The objective was to determine the prevalence of onchocerciasis among communities living in previously known foci. A total number of 1186 persons was included in the study. The infection rate among the communities studied ranged from 0pc to 67pc. The most frequent clinical signs and symptoms of onchocerciasis were: pruritus (80pc); rough skin (46pc); skin rash (30pc); leopard skin (6pc) and sclerosing keratitis (7pc). 3.6pc of all cases with onchocercasis were found to have no perception of light. The total number of cases in the district was estimated to be 32;000. The study showed that the foci; where Simulium neavei is the vector; are still active. In contrast; very few infections with Onchocerca volvulus were found in the Rwenzori focus; where S. damnosum s. 1. was the vector. The results indicate that onchocerciasis is of public health importance in Kabarole district and needs to be controlled