Background Diarrhea is the second leading cause of infectious deaths in children under-five globally. Oral rehydration salts (ORS) and zinc could avert an estimated 93% of deaths, but progress to increase coverage of these interventions has been largely stagnant over the past several decades. The Clinton Health Access Initiative (CHAI), along with donors and country governments in India, Kenya, Nigeria, and Uganda, implemented programs to scale-up ORS and zinc coverage from 2012 to 2016. The programs sought to demonstrate that increases in pediatric diarrhea treatment rates are possible at scale in high-burden settings through a holistic approach addressing both supply and demand barriers. We describe the overall program model and the activities undertaken in each country. The overall goal of the paper is to share the program results and lessons learned to inform other countries aiming to scale-up ORS and zinc. Methods We used a triangulation approach, using population-based household surveys, public facility audits, and private outlet surveys, to evaluate the program model. We used pre- and post-program population-based household survey data to estimate the changes in coverage of ORS and zinc for treatment of diarrhea cases in children under-five in program areas. We also conducted secondary analysis of Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) surveys in surrounding regions and compared annual coverage changes in the CHAI-supported program geographies to the surrounding regions. Results Across CHAI-supported focal geographies, the average ORS coverage across the program areas increased from 35% to 48% and combined ORS and zinc coverage increased from 1% to 24%. ORS coverage increases were statistically significant in the program states in India, from 22% (95% confidence interval CI = 21–23%) to 48% (95% CI = 47–50%) and program states in Nigeria, from 38% (95% CI = 32–40%) to 55% (95% CI = 51–58%). For combined ORS and zinc, coverage increases were statistically significant in all program geographies. Compared to surrounding regions, the estimated annual changes in combined ORS and zinc coverage were greater in program geographies. Using the Lives Saved Tool and based on the coverage changes during the program period, we estimated 76 090 diarrheal deaths were averted in the program geographies. Conclusions Increasing ORS and zinc coverage at scale in high-burden countries and states is possible through a comprehensive approach that targets both demand and supply barriers, including pricing, optimal product qualities, provider dispensing practices, stocking rates, and consumer demand.

This paper reviews the oral health care system of delivery in Uganda as accurately as possible given the limited research base. The paper looks into the evolution of dentistry in Uganda as well as the havoc wrecked on health care in general by two decades of civil strife in an effort to find explanations for the poor performance of the oral health system. Alternative methods of service delivery are suggested drawing from the rich experiences of countries like Sri Lanka and Tanzania. The alternative model highlights the need for a Primary Health Care approach to oral health service delivery implemented in a systematic manner. The paper concludes with a call to all Ugandan oral health workers to take personal and collective responsibility for the improvement of oral health outcomes of 24 million Ugandans through research, advocacy, adherence to professional ethics and continued education.

Timely response to health care seeking for diarrhoea episodes has a high potential to reduce child mortality rates.This study aimed to investigate the factors influencing timely response to health care seeking for diarrheal episode among children under five by caregivers. A cross-sectional research design that involved qualitative and quantitative research methods was conducted among 1,780 systematically selected households. Multiple logistic regressions were carried out to identify the factors associated with timely health care seeking behaviors among caregivers. Over 76% (95% CI: 72.8-78.4%) of the caregivers sought treatment in the first 24 hours after the onset of the diarrhea episode. Caregivers who were aged 30-39 were 0.63 times less likely to seek timely treatment for diarrhea episode (adjusted odds ratio (AOR) =0.83, 95%CI: 0.34-1.99) compared to caregivers who were aged 19-29 years. Female caregivers were 1.95 times more likely to seek timely treatment (adjusted odds ratio (AOR) =1.95, 95%CI: 1.05-1.11) compared to males. Those caregivers who had no education were 0.32 times less likely to seek timely treatment (adjusted odds ratio (AOR) =0.51, 95%CI: 0.69-1.09) compared to caregivers that had secondary education. Caregivers who knew the signs of diarrhoea were 0.97 times more likely to seek timely treatment (adjusted odds ratio (AOR) =0.97, 95%CI: 0.54-3.32) compared to caregivers who did not know the signs of diarrhea. Caregivers who believed that diarrhea kills were 2.41 times more likely to seek timely treatment (adjusted odds ratio (AOR) =2.41, 95%CI: 2.03-2.94) compared to caregivers who did not believe that diarrhea kills. Caregivers who stayed near the health units (≤5km) were 0.57 times likely to seek timely health care compared to those who stayed in far places. Health care seeking within 24 hours for diarrheal episodes among children under five by caregivers was found to be high in the selected study areas. Knowledge about signs of diarrhoea, belief that diarrhoea kills, knowledge about administering ORS, fair transport cost, waiting time and distance from the health units are the factors that influence timely health seeking among children with diarrhoea. The study recommends intensification of timed and targeted counseling (ttC) of caregivers about timely health seeking in the subsequent programming and equipping VHTs with diarrhea treatment medicines.

Uganda is one of 24 countries in the world where 70% of global maternal deaths occur. Evidence indicates that antenatal care (ANC) has both indirect and direct effects on maternal and perinatal morbidity and mortality reduction. In Uganda, the ANC attendance rate stands at 97.3% for one visit, but 59.9% for four or more visits. The aim of this quantitative study was to assess service- level factors affecting completion of ANC attendance defined by completion of four or more visits among women of reproductive age in a rural district in Uganda to contribute to design of patient-centered ANC services. Facility assessment scores on the service-level factors of interest for health facilities were obtained using a service level index tool. The relationship between the ANC completion rates of clients sampled from records at the health facilities and facility scores on service-level factors of interest were analyzed. Regression was conducted to determine the predictive relationship between ANC service availability, ANC service content, and ANC service organization, and completion of ANC attendance. The model was statistically significant, χ2 (6) = 26.118, p ˂ 0.05, and accounted for approximately 17.3% of the variance of ANC attendance completion (R2 = .173). Completion of ANC attendance was primarily predicted by better timing of provision of ANC services, and to a lesser extent by higher levels of availability of medicines and medical supplies. This study demonstrated that service-level factors have a predictive value for completion of ANC attendance. The findings can be used to improve availability, content, and organization of ANC services with the aim of enhancing positive experiences for clients and motivating them to complete the recommended number of ANC visits.

Uganda is one of 24 countries in the world where 70% of global maternal deaths occur. Evidence indicates that antenatal care (ANC) has both indirect and direct effects on maternal and perinatal morbidity and mortality reduction. In Uganda, the ANC attendance rate stands at 97.3% for one visit, but 59.9% for four or more visits. The aim of this quantitative study was to assess service- level factors affecting completion of ANC attendance defined by completion of four or more visits among women of reproductive age in a rural district in Uganda to contribute to design of patient-centered ANC services. Facility assessment scores on the service-level factors of interest for health facilities were obtained using a service level index tool. The relationship between the ANC completion rates of clients sampled from records at the health facilities and facility scores on service-level factors of interest were analyzed. Regression was conducted to determine the predictive relationship between ANC service availability, ANC service content, and ANC service organization, and completion of ANC attendance. The model was statistically significant, χ2 (6) = 26.118, p ˂ 0.05, and accounted for approximately 17.3% of the variance of ANC attendance completion (R2 = .173). Completion of ANC attendance was primarily predicted by better timing of provision of ANC services, and to a lesser extent by higher levels of availability of medicines and medical supplies. This study demonstrated that service-level factors have a predictive value for completion of ANC attendance. The findings can be used to improve availability, content, and organization of ANC services with the aim of enhancing positive experiences for clients and motivating them to complete the recommended number of ANC visits.