Acceptability of surgical care in Uganda: a qualitative study on users and providers.

OBJECTIVES: This study was conducted to assess acceptability of surgical care in Eastern Uganda and enable better allocation of resources, and to guide health policy towards increased surgical care seeking. DESIGN: This qualitative study used semistructured in-depth interviews that were transcribed and analysed by coding according to grounded theory. SETTING: The study was set in Eastern Uganda in the districts of Jinja, Mayuge, Kamuli, Iganga, Luuka, Buikwe and Buvuma. PARTICIPANTS: Interviews were conducted with 32 past surgical patients, 16 community members who had not undergone surgery, 17 healthcare professionals involved in surgical treatment and 7 district health officers or their deputies. RESULTS: The five intersecting categories that emerged were health literacy, perceptions, risks and fears, search for alternatives, care/treatment and trust in healthcare workers. It was also demonstrated that considering the user and provider side at the same time is very useful for a more extensive understanding of surgical care-seeking behaviour and the impact of user-provider interactions or lack thereof. CONCLUSION: While affordability and accessibility are well defined and therefore easier to assess, acceptability is a much less quantifiable concept. This study breaks it down into tangible concepts in the form of five categories, which provide guidance for future interventions targeting acceptability of surgical care. We also demonstrated that multiple perspectives are beneficial to understanding the multifactorial nature of healthcare seeking and provision.

Effectiveness of a novel bubble CPAP system for neonatal respiratory support at a referral hospital in the Philippines.

Aim: To examine the impact of introducing and implementing the Vayu bubble continuous positive airway pressure (bCPAP) system on neonatal survival and neonatal respiratory outcomes in a neonatal intensive care unit (NICU) in the Philippines. Methods: We compared clinical outcomes of 1,024 neonates before to 979 neonates after introduction of Vayu bCPAP systems into a NICU. The primary outcome was survival to discharge. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated. Analyses were undertaken separately for the entire NICU population and for neonates who received any form of respiratory support. Results: The introduction of the Vayu bCPAP system was associated with (1) significant reductions in intubation (aOR: 0.75; 95% CI: 0.58-0.96) and in the use of nasal intermittent positive-pressure ventilation (NIPPV) (aOR: 0.69; 95% CI: 0.50-0.96) among the entire NICU population and (2) a significant increase in survival to discharge (aOR: 1.53; 95% CI: 1.09-2.17) and significant reductions in intubation (aOR: 0.52; 95% CI: 0.38-0.71), surfactant administration (aOR: 0.60; 95% CI: 0.40-0.89), NIPPV use (aOR: 0.52; 95% CI: 0.36-0.76), and a composite neonatal adverse outcome (aOR: 0.60; 95% CI: 0.42-0.84) among neonates who received any form of respiratory support. Conclusion: The use of the Vayu bCPAP system in a NICU in the Philippines resulted in significant improvement in neonatal respiratory outcomes.