Background Human Pappilloma Virus (HPV) is the necessary cause of cervical cancer. A number of risk factors are believed to influence the role of HPV in the development of cervical cancer. This is so because majority of HPV infections are cleared and only a few are able to result into cancer. Chlamydia trachomatis (CT) is considered a potential cofactor in the development of cervical intraepithelial neoplasia (CIN), although different studies have produced contradicting information (Silins et al., 2005, Bellaminutti et al., 2014, and Bhatla et al., 2013). The objective of this cross-sectional study was to determine the prevalence and association of HPV-Chlamydial coinfection with cervical intraepithelial lesions and other risk factors for cervical intraepithelial lesions at a hospital in south western Uganda (MRRH). Methods The study included 93 participants, with an age range of 25 to 80 years, from whom cervical specimens were collected and enrolment forms were completed upon consent. Experienced midwives collected one cervical smear and two endocervical swabs from each participant. The swabs were used for HPV DNA and Chlamydia trachomatis antigen testing. Data was entered in Microsoft excel and analysed using STATA 12 software. With the help of spearman's correlation at the 0.05 level of significance, bivariate and multivariate analysis were done by logistic regression, to determine associations of risk factors to cervical lesions. Results The results showed the prevalence of HPV-Chlamydial coinfection to be 8.6% (8/93). Positive Pap smear results were found in 60.22% (56/93) participants, most of whom had low grade squamous intraepitherial lesion (LSIL) (54.84%). HPV-Chlamydial coinfection showed a significant correlation with a positive cytology result and only relatively significantly correlated with LSIL grade of cytological positivity. HPV was found to be the risk factors associated with cervical intraepithelial lesions at MRRH. Conclusion HPV, Chlamydia, and HPV-Chlamydial coinfection are prevalent infections and there is a likelihood of association between HPV-Chlamydial coinfection and with cervical intraepithelial lesions. This study recommends general sexually transimitted infections (STIS) screening for every woman that turns up for cervical cancer screening and a larger study, probably a multicentre study.

Background. Utilization of perinatal services in Uganda remains low, with correspondingly high rates of unskilled home deliveries, which can be life-threatening. We explored psychosocial and cultural factors influencing birthing choices for unskilled home delivery among postpartum women in rural southwestern Uganda. Methods. We conducted in-depth qualitative face-to-face interviews with 30 purposively selected women between December 2018 and March 2019 to include adult women who delivered from their homes and health facility within the past three months. Women were recruited from 10 villages within 20 km from a referral hospital. Using the constructs of the Health Utilization Model (HUM), interview topics were developed. Interviews were conducted and digitally recorded in a private setting by a native speaker to elicit choices and experiences during pregnancy and childbirth. Translated transcripts were generated and coded. Coded data were iteratively reviewed and sorted to derive categories using inductive content analytic approach. Results. Eighteen women (60%) preferred to deliver from home. Women’s referent birth location was largely intentional. Overall, the data suggest women choose home delivery (1) because of their financial dependency and expectation for a “natural” and normal childbirth, affecting their ability and need to seek skilled facility delivery; (2) as a means of controlling their own birth processes; (3) out of dissatisfaction with facility-based care; (4) out of strong belief in fate regarding birth outcomes; (5) because they have access to alternative sources of birthing help within their communities, perceived as “affordable,” “supportive,” and “convenient”; and (6) as a result of existing gender and traditional norms that limit their ability and freedom to make family or health decisions as women. Conclusion. Women’s psychosocial and cultural understandings of pregnancy and child birth, their established traditions, birth expectations, and perceptions of control, need, and quality of maternity care at a particular birthing location influenced their past and future decisions to pursue home delivery. Interventions to address barriers to healthcare utilization through a multipronged approach could help to debunk misconceptions, increase perceived need, and motivate women to seek facility delivery.

Background: Uganda's maternal mortality remains unacceptably high, with thousands of women and newborns still dying of preventable deaths from pregnancy and childbirth-related complications. Globally, Antenatal care (ANC) attendance has been associated with improved rates of skilled births. However, despite the fact that over 95% of women in Uganda attend at least one ANC, over 30% of women still deliver at home alone, or in the presence of an unskilled birth attendant, with many choosing to come to hospital after experiencing a complication. We explored barriers to women's decisions to deliver in a health care facility among postpartum women in rural southwestern Uganda, to ultimately inform interventions aimed at improving skilled facility births. Methods: Between December 2018 and March 2019, we conducted in-depth qualitative face-to-face interviews with 30 post-partum women in rural southwestern Uganda. The purposeful sample was intended to represent women with differing experiences of pregnancy, delivery, and antenatal care. We included 15 adult women who had delivered from their homes and 15 who had delivered from a health facility in the previous 3 months. Women were recruited from 10 villages within 20 km of a regional referral hospital. Interviews were conducted and digitally recorded in a private setting by a trained native speaker to elicit experiences of pregnancy and birth. Translated transcripts were generated and coded. Coded data were iteratively reviewed and sorted to derive descriptive categories using an inductive content analytic approach. Results: Regardless of where they decided to give birth, women wished to deliver in a supportive, respectful, responsive and loving environment. The data revealed six key barriers to women's decisions to deliver from a health care facility: 1) Fear of unresponsive care, fueling a fear of being neglected or abandoned while at the facility; 2) fear of embarrassment and mistreatment by health care providers; 3) low perception of risk associated with pregnancy and childbirth; 4) preferences for particular birthing positions and their outcome expectations; 5) perceived lack of privacy in public facilities; and 6) perceived poor clinical and interpersonal skills of health providers to adequately explain birthing procedures or support expectant or laboring women and their newborn. Conclusion: Anticipation of unsupportive, unresponsive, disrespectful treatment, and a perceived lack of tolerance for simple, non-harmful traditions prevent women from delivering at health facilities. Building better interpersonal relationships between patients and providers within health systems could reinforce trust, improve patient-provider interaction, and facilitate useful information transfer during ANC and delivery visits. These expectations are important considerations in developing supportive health care systems that provide acceptable patient-friendly care. These findings are indicative of the vital need for midwives and other health care providers to have additional training i...

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Introduction Despite the importance of debriefing, little is known about the effectiveness of training programs designed to teach debriefing skills. In this study, we evaluated the effectiveness of a faculty development program for new simulation educators at Mbarara University of Science and Technology in Uganda, Africa. Methods Healthcare professionals were recruited to attend a 2-day simulation educator faculty development course (Sim for Life: Foundations), covering principles of scenario design, scenario execution, prebriefing, and debriefing. Debriefing strategies were contextualized to local culture and focused on debriefing structure, conversational strategies, and learner centeredness. A debriefing worksheet was used to support debriefing practice. Trained simulation educators taught simulation sessions for 12 months. Debriefings were videotaped before and after initial training and before and after 1-day refresher training at 12 months. The quality of debriefing was measured at each time point using the Objective Structured Assessment of Debriefing (OSAD) tool by trained, calibrated, and blinded raters. Results A total of 13 participants were recruited to the study. The mean (95% confidence interval) OSAD scores pretraining, posttraining, and at 12 months before and after refresher were 18.2 (14.3–22.1), 26.7 (22.8–30.6), 25.5 (21.2–29.9), and 27.0 (22.4–31.6), respectively. There was a significant improvement from pretraining to posttraining (P < 0.001), with no significant decay from posttraining to 12 months (P = 0.54). There was no significant difference in OSAD scores pre– versus post–refresher training at 12 months (P = 0.49). Conclusions The Sim for Life Foundations program significantly improves debriefing skills with retention of debriefing skills at 12 months.

Increasingly, medical trainees are seeking global health electives (GHEs) as part of their medical education. However, little is known about the impact medical trainees undertaking global health electives have on host institutions, staff, local trainees, patients or communities in low-and middle-income countries. The goal of this study was to explore the relationship dynamics associated with global health electives as perceived by stakeholders at three sites in sub-Saharan Africa. More specifically, I examined stakeholder perspectives in Mwanza, Tanzania and Mbarara and Rugazi, Uganda where the University of Calgary Cumming School of Medicine (CSM) has long-standing institutional collaborations. In this case-based interpretive phenomenological study, thirty-four host stakeholders (health facility administrators, physicians, clinical officers, registrars, nurses, and community liaison members) participated in semistructured interviews and twenty-eight host stakeholders (medical students, residents, interns, and patients) participated in focus groups. Participant experiences were described using interpretive phenomenological analysis techniques. The findings revealed that although GHEs are well-established and a common experience for host stakeholders there are many indistinct aspects which are poorly understood by host stakeholders. Participants acknowledged that there are a variety of benefits they gain because of GHEs, but overall visiting medical trainees benefit the most from this unique learning opportunity. Despite reluctance to directly admit to harms, host stakeholders described significant challenges and burdens of GHEs and recommended ways in which GHEs could be improved to ensure that the relationships they depend on are mutually beneficial and equitable. One of the main recommendations from this study is that to work towards an equitable, effective, and ethical elective, GHEs should occur between collaborating institutions with a bidirectional focus.

Background Oral diseases are estimated to affect half of people living with HIV in the western world, and are often marked by pain, discomfort, disfigurement and reduced quality of life. Both HIV-specific and antiretroviral therapy-associated oral diseases have been found in this population. However, the prevalence, correlates and treatment needs of dental caries among people on antiretroviral therapy has not been well studied in rural Africa where majority of people living with HIV reside. Moreover, health behaviors and access to dental care vary significantly from high-income countries in the global north. Methods A cross-sectional study was conducted among people living with HIV attending a high-volume HIV clinic with an enrollment of 10,000 patients in a regional referral hospital in Southwestern Uganda. The clinic is located in an urban setting with a large rural catchment area. Oral health data was collected using the modified World Health Organization oral health questionnaire for adults. Dental examinations were conducted to identify and classify dental caries using the decayed, missing, filled, teeth (DMFT) index and compute the treatment need. Logistic regression models were employed to identify correlate of dental caries. Results A total of 194 participants were included in the study. The majority were female (124/194, 63.9%) with a median age of 42 years (IQR 36–49). The prevalence of dental caries experience among study participants was 67%, (130/194, 95% CI 60–75%). The mean DMFT index score was 4 (IQR 2–6) and treatment need was 96% (192/200). A higher CD4 count was associated with the presence of dental caries (OR 0.403, 95% CI 0.175–0.932) although it was not significant in multivariate analysis. Conclusion There is a high prevalence of dental caries among people living with HIV on ART in Uganda. Our data demonstrate a high oral treatment need among this population. We recommend inclusion of preventive and therapeutic oral care into HIV care in this region.

Background. Community-based education research and service (COBERS) is a platform for embedding progressive transformative leadership and research-related medical education in Uganda. The leadership development programme (LDP) developed at Mbarara University of Science and Technology (MUST), Uganda is a key component of COBERS. Health science students at MUST are equipped by means of the LDP with leadership knowledge and skills, and a positive attitude towards leadership and rural communities. The programme involves employing interactive learner-centred education techniques, with the opportunity to implement these skills in a community setting immediately after the training. Objective. To assess the students' self-reported perception and effectiveness of the precommunity placement LDP at MUST and its impact during the community clinical placement, and to measure the self-reported improvement of students' knowledge and their application of leadership skills in the community. The results of the evaluation will improve and build on this educational programme. The study also evaluated the effectiveness of the preplacement leadership training course for undergraduates at MUST, as reported by students. Methods. The programme evaluation of the LDP used quantitative pretest and post-test measures and qualitative data from focus group discussions to enrich the evaluation. Data were collected from students before and after the 1-week leadership training course using the same self-administered questionnaire. Variables were then compared to evaluate the impact of the LDP. Results. Prior to the intervention, only 14% of the participants had ever attended a leadership training session. There was significant self-reported change in the task accomplishment skills, interpersonal relationship skills and quality of leadership. Conclusion.The results suggest that the LDP may increase leadership skills among health science students to improve healthcare in Uganda. Our study recommends that this leadership programme be considered for use by Ugandan medical training faculties and similar environments elsewhere. This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Afr J Health Professions Educ