ABSTRACT
Background: The WHO and the US. CDC documented that facemask-wearing in public situations is one of the most important prevention measures that can limit the acquisition and spread of COVID-19. Considering this, WHO and US. CDC developed guidelines for using facemasks in public settings. This study aimed to determine correlates and prevalence of facemask wearing during COVID-19 pandemic among adult population of Northern Uganda. Methods. We conducted a cross-sectional study on five hundred and eighty-seven adult population of northern Uganda. A single stage stratified, and systematic sampling methods were used to select respondents from twenty-four Acholi subregions health facilities. Data was collected in a face-to-face questionnaire interview with an internal validity of Cronbach's =0.72. A local IRB approved the study, and Stata 18 was used for data analysis at multivariable Poisson regression with a p-value set at [≤]0.05. Results: The most substantial findings from this study were the high prevalence of face mask-wearing in public among respondents [88.7%,95%CI:86%-91%]. At a multivariable Poisson regression analysis, we found that obese respondents were 1.12 times more likely to wear facemasks than those who were not, [adjusted Interval Rates Ratios, aIRR=1.12,95%CI:1.04-1.19;p<0.01], and respondent who agreed to the lockdown measures were 1.23 times more likely to wear facemasks during COVID-19 pandemic than those who did not, [aIRR=1.23, 95%CI:1.07-1.41;p<0.01]. Other sociodemographic characteristics such as sex, age, occupation, level of education, religion, tribes, marital status, nationality, race, and comorbidities were not statistically significant at 95% Confidence Intervals. Conclusion: The most significant findings from this study were the high prevalence of face mask-wearing among adult community members in northern Uganda. The correlates of facemask wearing in public were the obese and respondents who agreed with the presidential directives on the lockdown measures. Although this was within acceptable prevalence rates, the strict enforcement of face mask-wearing by security forces raised concerns among many community members and human rights advocates. We recommend more studies on communities' perspectives on the challenges and benefits of facemask-wearing during the COVID-19 pandemic.
Subject(s)
COVID-19 , ObesityABSTRACT
Background: The ongoing Coronavirus disease 2019 (COVID-19)pandemic has significantly impacted the physical and mental health of the general population world-wide with healthcare workers (HCWs) at particular risk. The effect of the pandemic on the mental wellbeing of healthcare workers has been severe and characterized by depression, anxiety, work related stress, sleep disturbances and post-traumatic stress disorders (PTSD). Therefore, protecting the mental wellbeing of HCWs is a major priority. This review is intended to determine identifiable risk factors for adverse mental health outcomes, and any protective or coping measures to mitigate the harmful effects of the COVID-19 crisis among HCWs in sub-Saharan Africa. Methods: We performed a literature search using PubMed, Google Scholar, Cochrane Library and Embase for relevant materials. All articles published between March 2020 and April 2022 which were relevant to the subject of review and met a pre-defined eligibility criteria were obtained. A total of 23 articles were selected for the initial screening and 12 articles were included in the final review. Result: A total of 5,323 participants in twelve studies predominantly from Ethiopia (08 studies), one each from Uganda, Cameroon, Mali, and Togo fulfilled the eligibility criteria. Investigators found 16.3–71.9% of HCWs with depressive symptoms, 21.9-73.5% with anxiety symptoms, 15.5-63.7% experienced work-related stress symptoms, 12.4-77% experienced sleep disturbances, and 51.6-56.8% reported PTSD symptoms. Healthcare workers especially those working in emergency units, intensive care units, infectious disease wards, pharmacies and laboratories were at higher risk of developing adverse mental health impact. HCWs had profound fear, very anxious and stressed with the high transmission rate of the virus among themselves, high death rates among their patients, and lived in constant fear of infecting their families and self. Other sources of fear and work-related stress were lack of standardized PPEs, lack of known treatment and vaccines to protect themselves against the virus. HCWs faced stigma, abuse, financial problems, and lack of support. Conclusion: The prevalence of depression, anxiety, insomnia, and PTSD in HCWs in sub-Saharan Africa during the COVID-19 pandemic has been high. Several organizational, community and work-related challenges and interventions were identified including improvement of workplace infrastructures, the adoption of correct and shared infection control measures, provision of standardized personal protective equipment (PPE), social support and the implementation of resilience training programs. Setting up permanent multidisciplinary mental health teams, at regional and national levels to deal with mental health issues and providing psychological support to patients and HCWs, supported with long term surveillance and sufficient budgetary allocation is recommended.
Subject(s)
COVID-19ABSTRACT
Background With the advent of the novel coronavirus disease (COVID-19) and the severe second wave that caused high-profile deaths, hospitalization, and high treatment costs in Uganda, the population has raised concerns about enacting the national health insurance coverage bill. As of March 31, 2021, when Uganda was beginning to experience the second wave of COVID-19, the Parliament of Uganda passed a national health insurance bill that outlined the general structure for the first national health insurance scheme. The bill had pre-set benefit packages including a wide range of essential health services such as family planning, vaccination, and counseling. The plan was proposed to be financed by a combination of employers and government contributions and aimed to cover all Ugandans when fully implemented. The policy and implementation details would evolve when the President enacts it into law. This study aimed to determine the prevalence of health insurance coverage and factors associated with COVID-19 vaccine acceptance among participants in northern Uganda and use findings to show its implications on Uganda's achievement of Universal Health Coverage and Sustainable Development Goals. Methods We conducted a cross-sectional study among seven hundred and twenty-three adult participants from northern Uganda. Participants were selected randomly and consecutively. We used a questionnaire with an internal validity of Cronbach's a=0.772 to collect quantitative data from participants. A local IRB approved the study, and we used SPSS version 25.0 for data analysis. A p-value less or equal to 0.05 was considered significant. Results The prevalence of health insurance coverage among the study population was low, 57/723(7.9%), with most insured 42/57(73.7%), accepting the COVID-19 vaccine with a mean age of 33.81 years SD+8.863 at 95% CI:31.46-36.16 and a median age of 35 years. Participants without insurance coverage but who accepted the COVID-19 vaccine were 538/723(74.4%) with a mean age of 31.15 years SD+10.149 at 95% CI:30.38-31.92 and a median of 29 years. The insured and uninsured ages range from 18-52 years and 18-75 years, respectively. COVID-19 vaccine acceptance was higher among the insured 42/57(73.7%), and the likelihood ratio for insured participants to accept than reject the COVID-19 vaccine was 9.813; df=4; p=0.044. Widows, divorcees, and married separate, participants from remote districts (Nwoya and Lamwo), and those without formal education had no health insurance cover. However, in a multivariable logistic regression analysis, health insurance coverage was not an independent predictor of COVID-19 vaccine acceptance AoR=1.501,95%CI:0.807-2.791; p=0.199. Conclusion As the world grapples with the control of COVID-19, vaccine acceptance and health insurance coverage have become critical issues to be handled by each country. The health insurance coverage among participants from northern Uganda was low at 57/723(7.9%). Most participants with health insurance coverage accepted the COVID-19 vaccines compared to those who did not. The lack of health insurance coverage among most study participants is problematic as the world looks toward attaining UHC and SDGs. We proposed that Uganda's national social health insurance scheme, which is not legal, is urgently reviewed and signed to allow Uganda's population access to the needed health services.
Subject(s)
COVID-19 , Coronavirus InfectionsABSTRACT
Background: The ongoing Coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the physical and mental health of the general population worldwide, with healthcare workers (HCWs) at particular risk. The pandemic's effect on healthcare workers' mental well-being has been severe and characterized by depression, anxiety, work-related Stress, sleep disturbances, and post-traumatic stress disorders (PTSD). Therefore, protecting the mental well-being of HCWs is a significant priority. This review is to determine identifiable risk factors for adverse mental health outcomes and any protective or coping measures to mitigate the adverse effects of the COVID-19 crisis among HCWs in sub-Saharan Africa.Methods: We performed a literature search using PubMed, Google Scholar, Cochrane Library, and Embase for relevant materials. We obtained all articles published between March 2020 and April 2022 relevant to the review subject and met pre-defined eligibility criteria. We selected twenty-three articles for the initial screening, and we included twelve papers for the final review.Result: A total of 5,323 participants in twelve studies predominantly from Ethiopia (08 studies), one from Uganda, Cameroon, Mali, and Togo fulfilled the eligibility criteria. Investigators found that 16.3–71.9% of HCWs with depressive symptoms, 21.9-73.5% with anxiety symptoms, 15.5-63.7% experienced work-related stress symptoms, 12.4-77% experienced sleep disturbances, and 51.6-56.8% reported PTSD symptoms. Healthcare workers, especially those working in emergency, intensive care units, infectious disease wards, pharmacies, and laboratories, were at higher risk of developing adverse mental health impacts. HCWs had profound fear, were very anxious and stressed with the high transmission rate of the virus and high death rates among their patients and lived in constant fear of infecting their families and themselves. Other sources of fear and work-related Stress were the lack of standardized PPEs and available treatment and vaccines to protect themselves against the virus. HCWs faced stigma, abuse, financial problems, and lack of support.Conclusion: The prevalence of depression, anxiety, insomnia, and PTSD in HCWs in sub-Saharan Africa during the COVID-19 pandemic has been high. Several organizational, community, and work-related challenges and interventions were identified, including improvement of workplace infrastructures, adoption of correct and shared infection control measures, provision of standardized personal protective equipment (PPE), social support, and the implementation of resilience training programs. Setting up permanent multidisciplinary mental health teams at regional and national levels to deal with mental health issues and providing psychological support to patients and HCWs, supported with long-term surveillance and sufficient budgetary allocation, is recommended.
Subject(s)
COVID-19ABSTRACT
Introduction: Although COVID-19 first spread slowly in the African continent, confirmed virus cases have risen steadily since March 2020. The rapid spread of SARS-CoV-2 can be attributed to its numerous characteristics, including its high transmissibility, asymptomatic persons’ ability to shed the virus, vast numbers of asymptomatic persons, or mild symptoms but with the ability to transmit the virus, new variants, and super-spreading events. Poor public health practices, disbeliefs, myths, and misconceptions about the virus and its origin in many African communities are the other reasons for its rapid spread. This study aimed to determine the perceptions of the adult population in northern Uganda on the COVID-19 vaccine acceptance, disaggregated by age groups.Methods: A cross-sectional study was conducted between March and April 2022 to assess COVID-19 vaccine acceptance among seven hundred and twenty-three adult populations selected randomly from the nine districts of the Acholi sub-region. A five-point Likert scale with responses categorized as Strongly Agree, "SA," Agree, "A," Neutral, "N," Disagree, "DA," and Strongly Disagree, "SD" was used to assess participants' acceptance of the COVID-19 vaccines. Ethical approval was obtained from a local IRB, and SPSS version 20.0 was used to perform multivariable logistic regression to identify factors associated with vaccine acceptance. A p-value less than 0.05 was considered significant.Results: The most significant finding was that COVID-19 vaccine acceptance among the adult population in northern Uganda disaggregated by age groups was not statistically significant (χ2=3.956; p=0.142). COVID-19 vaccine acceptance among the age groups was associated with trust in the information from the mainstream media χ2=20.105; p=0.000; Government of Uganda χ2=19.900; p=0.028 and social media 10.745; p=0.030. The independent predictors on perceptions of the COVID-19 vaccine acceptance among age groups were; Participants strongly agreed on its importance to protect them from the virus AoR=4.99;95% CI:1.626-15.337;p=0.005; Agreed that the vaccine would protect them from the virus AoR=3.44;95%CI:1.225-9.650;p=0.019; strongly agreed that the side effects of the vaccine would stop them from receiving the vaccine AoR=0.330; 95%CI:0.125-0.856; p=0.023; They were neutral on whether the side effects of the COVID-19 vaccine would stop them from getting a COVID-19 jab AoR= 0.320; 95%CI:0.108-0.952;p=0.027; would not accept to pay for the COVID-19 vaccine AoR=0.280;95%CI:0.093-0.866; p=0.027; Agreed that children could take a COVID-19 vaccine AoR= 0.260; 95%CI:0.105-0.626;p=0.003; Strongly agreed that children could return to school before the COVID-19 vaccination AoR= 2.330; 95%CI:1.103-4.916;p=0.027; and agreed that children could return to school before taking COVID-19 vaccines AoR= 3.320; 95%CI:1.225-9.014;p=0.018.Conclusion: COVID-19 vaccine acceptance among the study population disaggregated by age group was not significant despite the disinformation and misinformation in the Ugandan media. The independent determinants of COVID-19 vaccine acceptance were the importance of the vaccine in protecting against the virus, that the vaccine’s side effects could stop them from taking the vaccine, and that children could take the COVID-19 jab but could return to school before taking the COVID-19 jab. The fear of family members contracting the virus and self-isolation when infected contributed significantly to the COVID-19 vaccine acceptance among participants in northern Uganda. There is a need for health managers to engage, sensitize and mobilize the population by addressing concerns about long-term and immediate side effects to increase the COVID-19 vaccine uptake in this community.
Subject(s)
COVID-19ABSTRACT
Background When the COVID-19 vaccines arrived in Uganda in early March of 2021, there was a lack of information on the vaccine acceptance in the population due to many factors, mainly misinformation and disinformation circulating in the Ugandan social and mainstream media. This study aimed to determine factors associated with COVID-19 vaccine acceptance among the adult population in northern Uganda.Methods We conducted a cross-sectional study among the 723-adult population in northern Uganda. Participants were selected randomly from the nine districts of the Acholi sub-region. Ethical approval was obtained from a local IRB, and SPSS version 20.0 was used for data analysis at a multivariable logistic regression. A p-value less than 0.05 was considered significant.Results The most significant finding was that COVID-19 vaccine acceptance among the adult population in northern Uganda was at 580/723(80.22%) and was significantly associated with those with comorbidities AoR = 0.397, 95%CI: 0.233,0.674; p = 0.001; those who agreed that vaccines in health facilities in northern Uganda were safe AoR = 0.724, 95%CI:0.597,0.878;p = 0.001; graduates AoR = 2.781,95%CI:1.278,6.052;p = 0.010; females AoR = 0.616, 95%CI:0.396,0.957; p = 0.031; Catholics AoR = 1.703,95%CI:1.048,2.765;p = 0.032; Baganda tribe AoR = 3.829,95%CI:1.170,7.790;p = 0.026; non-smokers AoR = 7.349,95%CI:1.767,30.566;p = 0.006; ex-smokers AoR = 8.687,95%CI:1.052,71.734;p = 0.045; Agago district AoR = 2.950,95%CI: 1.118,7.789; p = 0.029, and Lamwo district AoR = 2.781, 95%CI:1.278,6.052; p = 0.010.Conclusion COVID-19 vaccine acceptance among the study population was encouragingly high despite the disinformation and misinformation in the Ugandan media. The independent determinants of COVID-19 vaccine acceptance were among females, those who agreed that vaccines in health facilities were safe, those with comorbidities, graduates, Catholics, Baganda tribe, ex-smokers and non-smokers, and participants from Agago and Lamwo districts. The fear of contracting the coronavirus and the fear of death if not vaccinated contributed significantly to the COVID-19 vaccine acceptance in northern Uganda. There is a need for health managers to engage, sensitize and mobilize the population on the COVID-19 vaccine and vaccination using the VHTs and the catholic church structures, which remain critically important for the vaccination campaign if the high COVID-19 vaccine acceptance in the sub-region is to be maintained or improved.
Subject(s)
COVID-19ABSTRACT
Background: Ever since the appearance of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease (COVID-19) in Wuhan in mid-December 2019, its spread has been dramatic worldwide. It became apparent that the number of pediatric COVID-19 patients was much lower than in adults. Variable clinical presentations and progression have characterized morbidity and mortality in children and young adults. Objective The objective of this study was to assess the characteristics of the COVID-19 among children and adolescents below 20 years in Northern Uganda and determine factors associated with treatment outcomes in the study population. Materials and Methods A cross-sectional study conducted a retrospective data abstraction of the COVID-19 patients registered in the Gulu Hospital Health Management Information System (HMIS) database and other tools. The study covered the period between March 2020 and October 2021. Data that met the inclusion criteria were consecutively extracted from the Gulu Hospital HMIS database. A local IRB approved the study. SPSS version 25.0 was used for data analysis, and a p-value less than 0.05 was considered significant. Results There were 41 COVID-19 patients below 20 years among the 664 total COVID-19 patient population, constituting 41/664(6.2%) of the total COVID-19 patients treated at Gulu Regional Referral Hospital from March 2020 to October 2021. The median age was 19 years (ranging from 13 to 20 years), the mean age was 18.2 years SD±1.95 at 95% CI:17.51-18.74. Females constituted 58.5% of the study population. The mean duration of hospital stay was 14.44 days SD±10.45 at 95% CI:11.14-17.74, and the mean duration of symptoms at admission was 7.96 days SD±7.38 at 95% CI:4.84-11.07. The comorbidities were cardiovascular diseases 3/41(7.3%) and hypertension 3/41(7.3%) and were not in the same patients. Pneumonia 1/41(3.3%) and acute liver injury 1/41(3.3%) were the observed complications. The morbidity and mortality rates were 2/41(4.9%) and 0/41(0.0%), respectively. Participants’ symptoms, signs, complications, and comorbidities by gender were not statistically significant. Conclusion Data showed excellent treatment outcomes of the COVID-19 among children and adolescents below 20 years in Northern Uganda with a recovery rate of 100.0%. The burden of symptoms of the illness, comorbidities, and complications was fewer. There is a need to conduct more extensive studies on the role played by age in the successful recovery of COVID-19 patients, even in a low-resource milieu.
Subject(s)
COVID-19 , Sialic Acid Storage Disease , Coronavirus InfectionsABSTRACT
Background: Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2), a virus that causes COVID-19, has overwhelmingly interrupted human activities worldwide, especially in the low-to-middle income countries. Not much is reported about exclusive challenges and opportunities presented by the COVID-19 pandemic in some remote communities in Africa. Objective The objective of this study was to assess the community’s views and perspectives on the challenges and opportunities of the COVID-19 pandemic in Northern Uganda. Methods We interviewed 36 participants (age range, 28-63 years), including health workers, civil servants, members of civil society, security forces, politicians, and staff of local government administration who were members of COVID-19 district task forces in Northern Uganda using qualitative study methods between August and September 2021. The initial selection of participants was purposeful, but the snowballing technique was later used to select others. The interview questions were pre-tested among health workers and laypersons who were not part of the main study. Participants described how the COVID-19 pandemic presented challenges and opportunities, and the experience could be used to strengthen community resolves to control the pandemic and any other in the future. A local IRB approved this study. Data were analyzed using thematic analysis. Results The current study findings revealed challenges but many opportunities during the COVID-19 pandemic in this community, including loss of lives and livelihoods, increased poverty, lack of personal protection equipment, uncertainties, stress, and anxiety among health workers in the community. However, it also offered opportunities for quality family time, increased engagement, sensitization, and mobilization of communities for health, improved general security of persons and property, increased budgets and logistics for government departments, reduced incidences of diarrheal diseases and road traffic accidents, increased incomes for task force members, and more interactions among members during task force meetings. Conclusion Although the COVID-19 pandemic presented enormous challenges to low-to-middle-income countries, there are opportunities in some communities that are worth mentioning. Information obtained in this study has practical lessons that disease control experts could use to develop strategies to organize communities better and conduct disease surveillance activities for the COVID-19 pandemic and others.
Subject(s)
COVID-19 , Dysentery , Anxiety Disorders , Severe Acute Respiratory SyndromeABSTRACT
Background: The advent of the novel coronavirus disease 2019 (COVID-19) has caused millions of deaths worldwide. There is a lack of data on the outcome of hospitalized African patients suffering from COVID-19.This study aimed at identifying factors associated with hospital mortality in patients who suffered from COVID-19 at Gulu Regional Referral Hospital in Northern Uganda from March 2020 to October 2021. Methods: : This was a single-center, retrospective study in patients hospitalized with confirmed COVID-19 at Gulu Regional Referral Hospital in Northern Uganda. Socio-demographic characteristics, clinical presentations, comorbidities, duration of hospital stay, and treatment were analyzed, and factors associated with increased odds of mortality were determined. Results: : Of the 664 patients treated, 661(99.5%) were unvaccinated, 632(95.2%) recovered and 32(4.8%) died. Mortality was highest in diabetics 11(34.4%), cardiovascular diseases 12(37.5%), hypertensive 10(31.3%), females 18(56.3%), > 50-year-olds 19(59.4%), no formal education 14(43.8%), peasant farmers 12(37.5%) and those who presented with difficulty in breathing/shortness of breath and chest pain 32(100.0%), Oxygen saturation (Sp0 2 ) <80 4(12.5%), general body aches and pains 31(96.9%), tiredness 30(93.8%) and loss of speech and movements 11(34.4%). The independent factors associated with mortality among the COVID-19 patients were females AOR=0.220,95%CI:0.059-0.827;p=0.030; Diabetes mellitus AOR=9.014, 95%CI:1.726-47.067;p=0.010; tiredness AOR=0.059,95%CI:0.009-0.371; p=0.0000; general body aches and pains AOR=0.066,95%CI:0.007-0.605; p=0.020; loss of speech and movement AOR=0.134,95%CI:0.270-0.660;p=0.010 and other comorbidities AOR=6.860, 95%CI:1.309-35.957;p=0.020. Conclusion: The overall hospital mortality was 4.8%. Older age, people with diabetics, females, other comorbidities, severe forms of the disease, and those admitted to HDU were significant risk factors associated with hospital mortality. More efforts should be made to provide “Enhanced shielding” to the most vulnerable population to avoid preventable morbidity and mortality of COVID-19 in Northern Uganda.
Subject(s)
COVID-19 , Movement Disorders , Diabetes Mellitus , Cardiovascular DiseasesABSTRACT
Background Coronavirus Disease 2019 (COVID-19) is a severe respiratory disease that results from infection with a new coronavirus (SARS-CoV-2). One of the most critical issues related to the COVID-19 is the high rate of spread, millions of people have been infected around the world, and hundreds of thousands of people have died till now. However, reports from Africa paint a different picture of the SARS-CoV-2 and its effects on the population.Objectives The objective of this study was to describe the characteristics of the COVID-19 patients treated at the Gulu Regional Referral Hospital and determine factors associated with COVID-19 manifestations, socio-demographic characteristics, and treatment outcomes from March 2020 to October 2021.Methods A retrospective data abstraction of all COVID-19 hospital admissions registered in the Gulu Health Management Information System (HMIS) database and other tools were conducted. The period of study was March 2020 to October 2021. Data that met the inclusion criteria were consecutively abstracted from the Gulu Hospital HMIS database. A local IRB approved the study. SPSS version 25.0 was used for data analysis, and a p-value of 0.05 was considered significant.Results Data suggests there were three waves of COVID-19 in Uganda. Those with comorbidities, e.g., Diabetes mellitus 38(5.7%), hypertension 83(12.5%), cardiovascular diseases 58(8.7%), HIV and AIDS 61(9.2%), and other comorbidities such as liver cirrhosis and hepatitis B 40(6.0%) were more susceptible and presented with severe forms of the disease. Antibiotics 662(99.7%), steroids 73(11.0%), vitamin C 564(84.9%), Ivermectin 7(1.1%), and Vitamin D 24(3.6%) were the most used medicines for the treatment of COVID-19 patients. Most COVID-19 patients were unvaccinated 661(99.5%). However, the recovery rate was 632(95.2%). The commonest complications were pneumonia 60(9.0%), chronic fatigue 49(7.4%), acute respiratory distress syndrome (ARDS) 37(5.6%), depression 20(3.0%), systemic infections 19(2.9%), nightmares 15(2.3%) and septic shock 8(1.2%). The Adjusted Odds Ratios (AOR) on factors associated with recovery were treated with steroids AOR=138.835 at 95% CI:12.258-1572.50; p<0.000 and Vitamin D AOR=0.016 at 95% CI:1.902-520.98; p=0.016.Conclusion This study showed successful management of COVID-19 patients in low-resource settings with a recovery rate of 95.2%. The admission pattern suggests Uganda had three waves of COVID-19, contrary to the official government position of two. Treatment with steroids and Vitamin D is associated with the recovery of COVID-19 patients. There is a need to conduct more extensive studies on the role played by the two drugs in the successful recovery of COVID-19 patients.