Background Improved Water, Sanitation and Hygiene (WASH) in Healthcare facilities (HCFs) is of significant public health importance. It is associated with a reduction in the transmission of healthcare acquired infections (HAIs), increased trust and uptake of healthcare services, cost saving from infections averted, increased efficiency and improved staff morale. Despite these benefits, there is limited evidence on availability of WASH services in HCFs in the Greater Kampala Metropolitan Area (GKMA). This study assessed the availability and status of WASH services within HCFs in the GKMA in order to inform policy and WASH programming. Methods A cross-sectional study was conducted in 60 HCFs. Availability of WASH services in the study HCFs was assessed using a validated WASH Conditions (WASHCon) tool comprising of structured interviews, HCF observations and microbial water quality analysis. Data were analysed using Stata 14 software and R software. Results Overall, 84.5% (49/58) and 12.1% (7/58) of HCFs had limited and basic WASH service respectively. About 48.3% (28/58) had limited water service, 84.5% (49/58) had limited sanitation service, 50.0% (29/58) had limited environmental cleanliness service, 56.9% (33/58) had limited hand hygiene service, and 51.7% (30/58) had limited waste management service. About 94.4% of public HCFs had limited WASH service compared to only 68.2% of private not for profit facilities. More health centre IIIs, 92.5% and health centre IVs (85.7%) had limited WASH service compared to hospitals (54.5%). Conclusions Our findings indicate that provision of water, sanitation, hand hygiene, environmental cleanliness, and health care waste management services within HCFs is largely hindered by structural and performance limitations. In spite of these limitations, it is evident that environmental cleanliness and treatment of infectious waste can be attained with better oversight and dedicated personnel. Attaining universal WASH coverage in HCFs will require deliberate and strategic investments across the different domains.

Background Despite the development and enforcement of preventive guidelines by governments, COVID-19 continues to spread across nations, causing unprecedented economic losses and mortality. Public places remain hotspots for COVID-19 transmission due to large numbers of people present; however preventive measures are poorly enforced. Supermarkets are among the high-risk establishments due to the high interactions involved, which makes compliance with the COVID-19 preventive guidelines of paramount importance. However, until now, there has been limited evidence on compliance with the set COVID-19 prevention guidelines. Therefore, this study aimed to measure compliance with the COVID-19 prevention guidelines among supermarkets in Kampala Capital City and Mukono Municipality Uganda. Methods A cross-sectional study was conducted among selected supermarkets in Kampala Capital City and Mukono Municipality in September 2020. A total of 229 supermarkets (195 in Kampala City and 34 in Mukono Municipality) were randomly selected for the study. Data were collected through structured observations on the status of compliance with COVID-19 prevention guidelines, and entered using the KoboCollect software, which was preinstalled on mobile devices (smart phones and tablets). Descriptive statistics were generated to measure compliance to the set COVID-19 Ministry of Health prevention guidelines using Stata 14 software. Results Only 16.6% (38/229) of the supermarkets complied with the COVID-19 prevention and control guidelines. In line with the specific measures, almost all supermarkets 95.2% (218/229) had hand washing facilities placed at strategic points such as the entrance, and 59.8% (137/229) of the supermarkets surveyed regularly disinfected commonly touched surfaces. Only 40.6% and 30.6% of the supermarkets enforced mandatory hand washing and use of face masks respectively for all customers accessing the premises. Slightly more than half, 52.4% (120/229) of the supermarkets had someone or a team in charge of enforcing compliance to COVID-19 measures and more than half, 55.5% (127/229) of the supermarkets had not provided their staff with job-specific training/mentorship on infection prevention and control for COVID-19. Less than a third, 26.2% (60/229) of the supermarkets had an infrared temperature gun for screening every customer, and only 5.7% (13/229) of the supermarkets captured details of clients accessing the supermarket as a measure to ease follow-up. Conclusion This study revealed low compliance with COVID-19 guidelines, which required mandatory preventive measures such as face masking, regular disinfection, social distancing, and hand hygiene. This study suggests the need for health authorities to strengthen enforcement of these guidelines, and to sensitise the supermarket managers on COVID-19 in order to increase the uptake of the different measures.

Background Poor indoor air quality (IAQ) is a leading cause of respiratory and cardiopulmonary illnesses. Particulate matter (PM2.5) and carbon monoxide (CO) are critical indicators of IAQ, yet there is limited evidence of their concentrations in informal urban settlements in low-income countries. Objective This study assessed household characteristics that predict the concentrations of PM2.5 and CO within households in an informal settlement in Fort Portal City, Uganda. Methodology A cross-sectional study was conducted in 374 households. Concentrations of PM2.5 and CO were measured using a multi-purpose laser particle detector and a carbon monoxide IAQ meter, respectively. Data on household characteristics were collected using a structured questionnaire and an observational checklist. Data were analysed using STATA version 14.0. Linear regression was used to establish the relationship between PM2.5, CO concentrations and household cooking characteristics. Results The majority (89%, 332/374) of the households used charcoal for cooking. More than half (52%, 194/374) cooked outdoors. Cooking areas had significantly higher PM2.5 and CO concentrations (t = 18.14, p ≤ 0.05) and (t = 5.77 p ≤ 0.05), respectively. Cooking outdoors was associated with a 0.112 increase in the PM2.5 concentrations in the cooking area (0.112 [95% CI: -0.069, 1.614; p = 0.033]). Cooking with moderately polluting fuel was associated with a 0.718 increase in CO concentrations (0.718 [95% CI: 0.084, 1.352; p = 0.027]) in the living area. Conclusions The cooking and the living areas had high concentrations of PM2.5 and CO during the cooking time. Cooking with charcoal resulted in higher CO in the living area. Furthermore, cooking outdoors did not have a protective effect against PM2.5, and ambient PM2.5 exceeded the WHO Air quality limits. Interventions to improve the indoor air quality in informal settlements should promote a switch to cleaner cooking energy and improvement in the ambient air quality.

Background Young psychoactive substance users exhibit high-risk behaviours such as unprotected sexual intercourse, and sharing needles and syringes, which increases their risk of Hepatitis B infection. However, there is limited evidence of screening, and vaccination status of this subgroup. The aim of this study was to establish the predictors of screening and completion of the hepatitis B vaccination schedule. Methods A cross-sectional study using respondent driven sampling was used to enrol respondents from twelve out of fifty-seven informal settlements in Kampala city. Data were collected using an electronic structured questionnaire uploaded on the KoboCollect mobile application, and analysed using Stata version 14. A “modified” Poisson regression analysis was done to determine the predictors of screening while logistic regression was used to determine the predictors of completion of the Hepatitis B vaccination schedule. Results About 13.3% (102/768) and 2.7% (21/768) of the respondents had ever screened for Hepatitis B, and completed the Hepatitis B vaccination schedule respectively. Being female (aPR 1.61, 95% CI: 1.11–2.33), earning a monthly income >USD 136 (aPR 1.78, 95% CI: 1.11–2.86); completion of the Hepatitis B vaccination schedule (aPR 1.85, 95% CI: 1.26–2.70); lack of awareness about the recommended Hepatitis B vaccine dose (aPR 0.43, 95% CI: 0.27–0.68); and the belief that the Hepatitis B vaccine is effective in preventing Hepatitis B infection (aPRR 3.67, 95% CI: 2.34–5.73) were associated with “ever screening” for Hepatitis B. Knowledge of the recommended Hepatitis B vaccine dose (aOR 0.06, 95% CI: 0.01–0.35); “ever screening” for hepatitis B (aOR 9.68, 95% CI: 2.17–43.16) and the belief that the hepatitis B vaccine is effective in preventing Hepatitis B infection (aOR 11.8, 95% CI: 1.13–110.14) were associated with completion of the hepatitis B vaccination schedule. Conclusions Our findings indicate a low prevalence of Hepatitis B screening and completion of the Hepatitis B vaccination schedule among young psychoactive substance users in informal settings. It is evident that lack of awareness about Hepatitis B is associated with the low screening and vaccination rates. We recommend creation of awareness of Hepatitis B among young people in urban informal settlements.

Background Indoor air pollutants (IAP) such as particulate matter (PM) and carbon monoxide (CO) are a leading cause of acute respiratory symptoms, and long-term health impacts such as respiratory diseases, heart diseases and cancers. In Uganda, literature on the effects of IAP on respiratory outcomes in informal settlements is limited. This study investigated the association of selected IAPs and cooking fuels with respiratory symptoms among children and adults. Methods This study was conducted among 284 households in an informal settlement in Uganda from April to May 2022. Information on indoor air conditions, fuel type and adults reported the respiratory symptoms of their children as well as their respiratory symptoms within the previous 30 days. Same-day concentrations of PM less than 2.5 μm (PM 2.5 ) and less than 10 μm(PM 10 ) in diameter were monitored from 9 am to 2 pm using Temptop M2000c 2 nd edition particle sensor while CO was measured using a carbon monoxide meter. Robust Poisson regression was used to model the associations between indoor air conditions, fuel type and respiratory health outcomes. Results: Approximately 94.7% of the households were using biomass fuels. Cough (66.2%), shortness of breath (33.5%) and phlegm (17.6%) were common respiratory symptoms in adults while in children, morning cough (80.0%), day or night cough (34.4%) and shortness of breath (26.5%) were reported. The median PM2.5, PM10 and CO levels were 49.5(IQR= 31.1, 86.2) µg/m 3 , 73.6(IQR= 47.3,130.5) µg/m 3 and 7.7(IQR= 4.1,12.5) ppm respectively. Increase in humidity was associated with higher levels of PM2.5 (ß = 2.74, p =0.004) and PM10 (ß= 4.14, p =0.002) however temperature increases were associated with lower levels of PM2.5 (ß = -11.72, p =0.009) and PM10 (ß= -16.36, p =0.008) but higher CO levels (ß=2.24, p = 0.032). Use of less polluting fuels such as electricity and gas were associated with low levels of PM 2.5 (ß= -31.36, 95%CI =-60.7 – -2.02) while home dampness (ß = 3.39, 95%CI =0.07 – 6.72) was associated with higher indoor CO levels. Dampness was associated with acute phlegm in adults (PR= 2.78, 95%CI =1.57 – 4.90) and outdoor cooking was found to be associated with lower shortness of breath risk (PR = 0.60,95%CI =0.40 – 0.91). Conclusion The prevalence of respiratory problems among adults and children was high. Poor indoor air conditions were associated with respiratory symptoms in adults and children. Efforts should be made to protect adults and children from the adverse effects of indoor air pollution.