Research on Diarrhoea in Uganda: Activities and GAPS

Introduction: The Ugandan CDD Programme was initiated in 1984. Since that time; a number of studies have been conducted at national local levels addressing different aspects of childhood diarrhoea. Despite the range of these studies; there is no central organised catalogue of the CDD studies and their findings. As a result of lacking an organised data base; there has been reduplication of some activities while other aspects have hardly been studied. Objectives: A joint CDD Programme/CHDC meeting in 1992 called for a study to review completed research on childhood diarrhoea; make an annotated bibliography and recommend research in aspects of childhood diarrhoea found lacking. Methods: A total of 29 reports on completed diarrhoea-related research conducted in Uganda between 1984 and 1992 were qualitatively reviewed. Information was extracted from the reports using pre-selected key questions. Results: Most studies had been carried out in the districts of Hoima; Kampala; Mbarara and Maindi. Little or no research has been done in the samll and remote districts e.g. Bundibugyo; Kapchorwa; Kisoro and the north and north-eastern part of the country. The most studied aspects of childhood diarrhoea were a) mother's knowledge of causes of diarrhoea b) maternal awareness and knowledge of preparation of ORS c) incidence of acute diarrhoea; and d) factors associated with a high incidence of dirrhoea. Studies of health provider management of diarrhoea have been limited to unit-based health workers and traditional healers. Management of diarrhoea by private practitioners and shop owners has hardly been studied. Despite frequent expression of concern about diarrhoea related deaths; there were no reports available documenting diarrhoeal diseases mortality. There were no interventional studies to assess the impact of related programmes on the incidence of diarrhoea; e.g. EPI; nutrition; water safety and availability; construction and use of latrines. Although discripancies were described between the knowledge of health workers and mothers on some aspects of diarrhoea; no study documented observation of health education sessions or made a critical analysis of health education materials. Different home available fluids were recommended for a child suffering from diarrhoea in different ethnic areas. Actual use of these fluids during diarrhoea was not observed; neither was the rationale for use determined. Conclusion: Considerable research has been done on diarrhoea particularly about maternal knowledge and practices for diarrhoea in their children. At the same time; a critical analysis of the achieved research has identified information gaps; especially regarding impact assessements; qualitative aspects of health education; and levels of diarrhoea mortality

Kasangati Health Centre Cost Recovery Programme 1988 to 1990

Background: Kasangati Health Centre (KHC) is a government health centres; as well as teaching centre for the Institute of Public Health (IPH) of Makerere University. Between 1983 and 1988; the Minnesota International Health Volunteers (MIV) in collabolation with IPH and offered financial and technical support to KHC. With the MHV contract coming to an end; there was a need to find a long-term source of funding to run the centre's activities. After months of discussions between the collaborators of Kasangati Health Centre; IPH; KHC staff; KHC Management committee and the Minsitry of Health; it was decided that a fee for service would be introduced to generate the necessary funds. the KHC Cost Recovery Programme was implemented