Factors associated with the utilization of inactivated polio vaccine among children aged 12 to 23 months in Kalungu District, Uganda.

Uganda officially introduced the inactivated polio vaccine (IPV) in May 2016 as part of the polio eradication strategy and integrated it into its routine immunization programme in addition to the oral polio vaccine. The current coverage stands at 60% as of July 2017. We therefore aimed to determine factors associated with the uptake of IPV among children in Kalungu District so as to inform the implementation of the vaccine policy. A community-based cross-sectional study was conducted among caregivers of 406 eligible children aged 12-23 months through multi-stage systematic sampling and a standardized semi-structured questionnaire. Nine key informant interviews were conducted through purposive selection of health care providers and members of Village Health Teams (VHTs) based on their expertize. Modified Poisson regression and thematic content analysis were used to determine factors significant to IPV uptake among children. 71% of sampled children aged 12-23 months had received IPV in Kalungu District. The survey found that being encouraged by health workers and VHTs was significant to children's uptake of IPV (Adjusted PR 1.24, 95% CI; 1.22-3.47). Distance to the immunization point (Adjusted PR 0.32,95% CI; 0.16-0.62) and caregiver's education level (Adjusted PR 1.16,95% CI; 1.05-2.22) were also associated with IPV uptake. Qualitative findings from health workers and VHT members further confirmed the perception that distance to the immunization post was important, and VHTs also stated that being encouraged by health workers was critical to IPV uptake. The current prevalence of IPV uptake among children aged 12-23 months in Kalungu is 71%, higher than the last reported national coverage (60%), though still below the recommended national coverage of 95%. Efforts should be focused on sensitization of caregivers through health workers and VHTs. Immunization outreach should be strengthened so as to bring services closer to patients.

Community Perspective on Policy Options for Resettlement Management: A Case Study of Risk Reduction in Bududa, Eastern Uganda.

INTRODUCTION: Despite existing policy actions on Disaster Risk Reduction (DRR), many community members in Bududa still continue to settle in high-risk areas re-zoned for nonsettlement. There seems to be an apparent information asymmetry on expectations between the community and Government. The challenge then is 'how to consult communities and seek their opinion in an adequately representative unbiased way'. This paper sets out to explore policy options on resettlement management as a DRR approach and how engaging with communities in a public discourse using the Deliberative Polling (DP) approach; to obtain their opinions and insights on these policy issues, revealed underlying challenges to policy implementation. METHODS: A qualitative study was conducted in Bududa in eastern Uganda with fourteen group discussions; comprising 12-15 randomly assigned participants of mixed socio-economic variables. Trained research assistants and moderators collected data. All discussions were audio taped, transcribed verbatim before analysis. Data were analyzed using latent content analysis by identifying codes from which sub-themes were generated and grouped into main themes on policy options for resettlement management. RESULTS AND DISCUSSION: We used Deliberative Polling, an innovative approach to public policy consultation and found that although the community is in agreement with most government policy options under resettlement management, they lacked an understanding of the rationale underlying these policy options leading to challenges in implementation. The community members seemed uncertain and had mistrust in government's ability to implement the policies especially on issues of compensation for land lost. Key Words: Policy, Deliberative Polling, Climate change, risk-reduction, landslides, Uganda.

Coping Strategies for Landslide and Flood Disasters: A Qualitative Study of Mt. Elgon Region, Uganda.

INTRODUCTION: The occurrence of landslides and floods in East Africa has increased over the past decades with enormous Public Health implications and massive alterations in the lives of those affected. In Uganda, the Elgon region is reported to have the highest occurrence of landslides and floods making this area vulnerable. This study aimed at understanding both coping strategies and the underlying causes of vulnerability to landslides and floods in the Mt. Elgon region. METHODS: We conducted a qualitative study in three districts of Bududa, Manafwa and Butalejja in the Mt. Elgon region in eastern Uganda. Six Focus Group Discussions (FGDs) and eight Key Informant Interviews (KIIs) were conducted. We used trained research assistants (moderator and note taker) to collect data. All discussions were audio taped, and were transcribed verbatim before analysis. We explored both coping strategies and underlying causes of vulnerability. Data were analysed using latent content analysis; through identifying codes from which basis categories were generated and grouped into themes. RESULTS: The positive coping strategies used to deal with landslides and floods included adoption of good farming methods, support from government and other partners, livelihood diversification and using indigenous knowledge in weather forecasting and preparedness. Relocation was identified as unsustainable because people often returned back to high risk areas. The key underlying causes of vulnerability were; poverty, population pressure making people move to high risk areas, unsatisfactory knowledge on disaster preparedness and, cultural beliefs affecting people's ability to cope. CONCLUSION: This study revealed that deep rooted links to poverty, culture and unsatisfactory knowledge on disaster preparedness were responsible for failure to overcome the effects to landslides and floods in disaster prone communities of Uganda. However, good farming practices and support from the government and implementation partners were shown to be effective in enabling the community to lessen the negative effects disasters. This calls for high impact innovative interventions focused in addressing these underlying causes as well as involvement of all stakeholders in scaling the effective coping strategies in order to build resilience in this community and other similarly affected areas. KEY WORDS: Coping, Underlying causes, Floods, Landslides, Mt. Elgon, Uganda.

Yellow fever vaccination coverage following massive emergency immunization campaigns in rural Uganda, May 2011: a community cluster survey.

BACKGROUND: Following an outbreak of yellow fever in northern Uganda in December 2010, Ministry of Health conducted a massive emergency vaccination campaign in January 2011. The reported vaccination coverage in Pader District was 75.9%. Administrative coverage though timely, is affected by incorrect population estimates and over or under reporting of vaccination doses administered. This paper presents the validated yellow fever vaccination coverage following massive emergency immunization campaigns in Pader district. METHODS: A cross sectional cluster survey was carried out in May 2011 among communities in Pader district and 680 respondents were indentified using the modified World Health Organization (WHO) 40 × 17 cluster survey sampling methodology. Respondents were aged nine months and above. Interviewer administered questionnaires were used to collect data on demographic characteristics, vaccination status and reasons for none vaccination. Vaccination status was assessed using self reports and vaccination card evidence. Our main outcomes were measures of yellow fever vaccination coverage in each age-specific stratum, overall, and disaggregated by age and sex, adjusting for the clustered design and the size of the population in each stratum. RESULTS: Of the 680 survey respondents, 654 (96.1%, 95% CI 94.9 - 97.8) reported being vaccinated during the last campaign but only 353 (51.6%, 95% CI 47.2 - 56.1) had valid yellow fever vaccination cards. Of the 280 children below 5 years, 269 (96.1%, 95% CI 93.7 - 98.7) were vaccinated and nearly all males 299 (96.9%, 95% CI 94.3 - 99.5) were vaccinated. The main reasons for none vaccination were; having travelled out of Pader district during the campaign period (40.0%), lack of transport to immunization posts (28.0%) and, sickness at the time of vaccination (16.0%). CONCLUSIONS: Our results show that actual yellow fever vaccination coverage was high and satisfactory in Pader district since it was above the desired minimum threshold coverage of 80% according to World Health Organization. Massive emergency vaccination done following an outbreak of Yellow fever achieved high population coverage in Pader district. Active surveillance is necessary for early detection of yellow fever cases.