Browsing by Author "Kimbugwe, Hassan"

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    An assessment of malaria prevention, diagnosis and treatment services in Uganda
    (Stellenbosch : Stellenbosch University, 2022-04) Kimbugwe, Hassan; Burger, Ronelle; Matovu, Fred; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Economics.
    ENGLISH SUMMARY: Government, donor partners, and the private sector invest large amounts of financial resources annually in malaria prevention and care. Despite substantial spending on malaria prevention programmes by 2019/2020, the disease still accounted for 13.3% Uganda's mortality, as well as 29.8% of outpatient visits and 34.9% of inpatient admissions. To combat malaria more effectively, it is critical to understand whether these substantial investments in malaria prevention and care reach those who are most vulnerable to malaria, and whether approved malaria diagnosis and treatment protocols are followed diligently. This PhD was thus structured to consider three distinct but related issues: (i) the equity of bed net use and ownership in 2009 and 2014, (ii) the uptake of malaria prophylaxis amongst pregnant women, and (iii) the relationship between financial incentives and appropriate malaria diagnosis and case management. The first essay examines the equity in access to and utilisation of bed nets in 2009 and 2014. It was found that the availability of bed nets increased over time. Access to and use of bed nets became more equitable, with higher levels of access and use amongst poorer households. Households with access to at least one bed net rose from 59.2% to 94.1%. The percentage of households who slept under bed nets increased from 51.8% to 72.6%. The percentage of children under five years who slept under bed nets increased from 45.8% to 81.5%. The percentage of pregnant women who slept under bed nets increased from 78.6% to 83.8%. Through recentered influence functions (RIF) decomposition method, the study examined whether the demographic factors were associated with the relationship between the wealth index and bed net utilisation in 2009 and 2014. Results suggest that in 2009, place of residence, number of nets in a household, mother’s education level, region and household size were associated with the relationship between wealth index and bed net utilisation. In 2014, age of household members, and mother’s education level were associated with the relationship between the wealth index and bed net utilisation. In both years having a mother with at least primary level of education was vital in promoting bed net utilisation. The results further indicate that younger household members, women, household members from the northern region, household members from the poorest wealth quintile, mothers with a post-secondary education, and households with more bed nets and few members were more likely to sleep under bed nets in 2014. The second essay reviews factors associated with uptake of intermittent preventive treatment (IPT) of three doses of Sulfadoxine-pyrimethamine (SP) (IPT-SP3) during pregnancy. The analysis indicated a double and notable improvement in uptake over time, from 9.91% in 2011 to 17.89% in 2016. However, the uptake was still far below the 79% target of Uganda’s Health Sector Strategic Plan (Uganda Ministry of Health (MoH) 2014). Results showed that uptake was higher amongst younger women (under the age of 25 years) than older women (above the age of 34 years), higher amongst women who attended their first antenatal care (ANC) visit early (during the first trimester) than those who attended later (during the third trimester), higher amongst women from the upper wealth quintile than women from the poorest quintile, and higher amongst women from the northern region of Uganda than among women from the central region. Results also indicated that uptake of IPT-SP3 was lower amongst women from the western region than women from the central region. Findings from the pooled model (unrestricted) indicate that the relationship between IPT-SP3 and the covariates in the two different time period (2011 and 2016) have not changed. The third and final essay focuses on the relationship between financial incentives and the likelihood of private providers adhering to national guidelines on malaria diagnosis and dispensing practices. The specific concern is that volume or revenue-based staff remuneration may provide a strong incentive for provision of malaria drugs to patients who have not yet tested for malaria. This tension is observed in a subsample where facilities do not have malaria testing capabilities and only sell malaria treatment and staff are paid based on the volume of drugs sold or the revenue. The results suggest that the private healthcare providers who receive salaries are more likely to adhere to malaria treatment protocols. Descriptive findings indicate significant variations between drug-shop attendants and other private healthcare providers with regard to malaria diagnosis, antimalarial dispensing practices, and adhering to malaria treatment procedure.