Academic submissions (CoBAMS)

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    Allocative inefficiency and its effects on general hospitals expenditure functions in Uganda
    (Makerere University, 2020-10) Ajanga, Max
    The increasing costs of healthcare arising largely from growing population and emergence of non-communicable diseases has exerted pressure on healthcare budgets in Uganda. With a finding gap of 7 percent to realize WHO recommended target of 15 percent or GDP. there is need for hospitals to be efficient in allocation of financial resources in order to provide the required level of healthcare services. Most studies on Uganda have focused on technical inefficiency of general hospitals, and evidence on their allocative inefficiency is limited. Understanding the sources of inefficiency in allocation of resources in general hospitals in Uganda is important to improve their performance. The purpose of this study is three fold: to determine the allocative inefficiency of general hospitals in Uganda, find the cost of allocative inefficiencies and its effect on the recurrent expenditure of general hospitals. Panel data from 22 general hospitals for the period 1997-2007 were used. Allocative inefficiency was estimated using Stochastic Frontier Analysis and the cost inefficiency by comparing actual and budgeted mean expenditure. The effect of allocative inefficiency on recurrent expenditures was examined using a Generalized Estimation Equation. The findings show that: overall general hospitals on average were 26 percent allocatively efficient. The allocative inefficiencies arose from payments of employee benefits (34.8 percent ). payments for utilities like electricity and water ( 14.1 %) and purchase of drugs (29.2%).Kenya. 29 percent of inefficiency is due labor. 52 percent drugs and 77 percent utilities (World Bank 20 14).The cost of Allocative inefficiency of general hospitals was 20 percent. Implying that the general hospitals caused a financial burden of 20 percent to health sector in Uganda. Furthermore, allocative inefficiency significantly affects the recurrent expenditure of general hospitals whereby a one percentage point increase in allocative inefficiency raises recurrent expenditure by 5.1 percent. To address the existing allocative inefficiencies general hospital in Uganda can improve the process of hire of labor and management of staff payroll: monitor procurement of drugs and reduce wastages in the use of utilities.
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    Assessment of the cost overruns in subcontracted construction projects in Uganda: A case study of Roko Construction
    (Makerere University, 2018-11-05) Ssali, Francis Pyrrah
    The study aimed at assessing the cost overrun in subcontracted construction projects in Uganda; with particular emphasis on Roko Construction Company limited a leading construction company in Uganda. The objectives of the study were; to identify the procedures of subcontracting and categories of construction projects that are subcontracted by Roko Construction Company Ltd in Uganda, to examine the causes of cost overruns in the subcontracted construction projects in Uganda and to propose strategic procedures to facilitate proper subcontracting in-order to avoid cost overruns on construction projects. The study employed descriptive cross-sectional design. Both Qualitative and Quantitative approaches were used during the research. The study employed purposive and systematic random sampling, a sample of 155 was adopted from a population of 253 respondents at Roko Construction. Primary data were obtained through the use of interview guides and semi-structured questionnaires which were formulated and conducted among different subcontractors, employees and management at Roko Construction Ltd. The study found that Roko Construction ltd used a mixed kind of procurement method for subcontractors depending on the nature of the project whether public or private. Factors that cause cost overruns in subcontracted projects were identified and included the following; Inflation, project variations, incomplete and design failures, Omissions, errors and project underestimations in the Bill of Quantities, lack of proper modes and channels of communication and absorption of allocated funds by stakeholders. The study identified and recommended adoption of the critical strategies for proper facilitation of subcontracted projects. These included the need to improve cost reporting and proper communication channels, encouraging the use of insurance covers, the need to change the subcontractor procurement method and encouraging full client involvement in subcontracting matters, requiring appropriate time schedules and quality assurance plans as well as strong safety practices.
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    Changes in malaria prevalence among children aged under five in Uganda from 2009 to 2014/15
    ( 2018-12-19) Kirwana, Venantius Bbaale
    Malaria remains a major public health problem in Uganda. The last two malaria indicator surveys show that malaria prevalence among children aged under-five years has reduced from 42% in 2009 to 19% in 2014/15. However, there is paucity of information explaining this reduction in relation to variations in household socio-demographic, socio-economic, and malaria prevention factors as well as their effects. This study therefore sought to understand how variations in these factors and their effects explain these temporal changes in malaria prevalence. A secondary analysis of the Uganda malaria indicator survey data of 2009 and 2014-15 was conducted. Data on 3,983 children from 4,421 households collected during the 2009 survey and 9,804 children from 5,345 households collected during the 2015-15 survey were analyzed. Multivariate logistic decomposition was used to assess the changes in malaria prevalence between 2009 and 2014-15 attributed to variations in changes (overtime) in household factors and effects of these factors. Logistic regression results indicated that sleeping under a mosquito bed net (p=0.016) and interior Indoor residual wall spraying (p=0.000) explain the observed reduction in malaria prevalence from 2009 to 2014-15. Multivariate decomposition showed that the variations in household factors contributed 2% and effect of these household factors 98% of the observed reduction in malaria prevalence. The analysis also highlighted that malaria prevalence would further reduce by 8.1% if the effect of interior wall spraying in 2009 was as high as one in 2014- 15, and the reduction would be statistically significant (p=0.000). Indoor residual spraying when used consistently overtime, alongside other important interventions such as, information education and communication via media and use of mosquito nets, can significantly reduce malaria prevalence overtime. Government should therefore consider implementing indoor residual spraying alongside other priority malaria control interventions such as mass media campaigns and universal distribution of insecticide treated mosquito nets.
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    A decomposition of differences in antenatal care attendance in the first trimester in East Central Uganda between 2006 and 2011
    (Makerere University, 2018-11-14) Okello, George Robert
    The objective of this study was to assess the differences in Antenatal Care (ANC) attendance in the first trimester between 2006 and 2011 in East Central Uganda. The changes were decomposed into components attributed to variations in characteristics of women and variations in the effect of predictors (coefficient). The assessment was based on data sourced from Uganda Demographic and Health Survey of 2006 and 2011 where 1,031 women aged 15-49 years were considered for the survey. The investigation was made using women’s predisposing factors, enabling factors and need factors which determine their attendance of ANC in the first trimester. The analysis was done in frequency distribution using a pooled logistic regression and a non-linear Oaxaca’s Blinder multivariate decomposition logistic regression. In the results, ANC attendance in the first trimester increased from 17% in 2006 to 23% in 2011. The difference in the characteristics of women were significantly (p<0.05) noted in the factors namely; knowledge on pregnancy complication, total children ever born and female headed household. Results show that 68.8% of the gap in ANC attendance in the first trimester was attributed to differences in the characteristics of women. The gap in ANC attendance in the first trimester would respectively be increased by 36.2%, 17.3% and 12.1% if women in 2006 had similar composition to that of their counter parts in 2011 with regard to knowledge on pregnancy complication, total children ever born and female headed household. The findings of this study indicate that overall, the gap in ANC attendance in the first trimester is attributed to variation in total children ever born, knowledge on pregnancy complication and household head. In order to reduce this gap, government and other development partners need to scale up ANC attendance in the first trimester by increasing knowledge on pregnancy complication through community outreaches, setting information, education, and communication (IEC) strategies designed to increase the awareness of danger signs in pregnancy, and encouraging women to attend ANC in the first trimester irrespective of the number of children they have because each pregnancy has its own complication.
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    Determinants of survival time among HIV positive patients after being initiated on Combivir. The case of Gulu Regional Referral Hospital in Uganda
    (Makerere University, 2018-12-12) Bamulangeyo, Michael Owen
    This study was aimed at identifying determinants of survival time among HIV positive patients after being initiated on Combivir. Majority of clients at this facility are initiated on Combivir as a preferred first line regimen and it’s based on this that we would like to assess effectiveness of this drug. The study assessed both demographic and clinical factors of 200 HIV positive clients initiated on Combivir at Gulu Regional Referral Hospital between 1st/01/2005, and 31st/12/2013. In addition to primary data collected, secondary data was extracted from the Gulu ART clinic data base and analyzed using univariate, bivariate and multi variate methods. This included running descriptive statistics, using the log rank test and fitting a Cox proportional hazard model to determine factors that had a significant association with the survival time of the patients. The findings show that survival was different across various categories of weight, levels of education, ART Adherence and baseline CD4 count. The survival of patients increased with increasing weight while the hazard reduced by 66% among patients that attained tertiary education compared to those with no education. Patients with good ART adherence had 46% reduced hazard compared to their counterparts with fair adherence while those who were initiated on Combivir with baseline CD4 >=350 had their hazard reduced by 13%. Survival time was not significantly different across various categories of gender and employment status (p>0.05). This implies that these factors seemed not to affect the duration of survival for HIV patients who have been initiated on Combivir. The study concluded that determinants of survival among HIV positive patients who have been initiated on Combivir are: Weight of the patient, level of Eeducation, ART adherence and CD4 count. The study recommended that initiation of Combivir be done early for HIV positive patients when CD4 is >=350 as recommended by WHO and national HIV treatment guidelines (2016) in Uganda. The drug should also be introduced when the patient weight is relatively high (>50kgs among adults) and Intensive Adherence Counselling should be emphasised to ensure good adherence
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    Effect of exchange rate fluctuations on Uganda’s imports (1998Q1 – 2016Q4)
    Asiimwe, Alex Jessey
    This study investigated the effect of exchange rate fluctuations on Uganda‟s imports from 1998 to 2016. The main approach used was the ordinary least squares to test for the long-run relationship. The error correction model was applied to test for short run relationship with the Error Correction Term to determine the speed of adjustment between the short-run and the long-run equilibrium and the Engle and Granger (1987) was applied to test for the long-run causal relationship between the variables. Quarterly data was used and 76 data points were used for analysis. The log-log model was used to ascertain the effect of exchange rate fluctuations on Uganda‟s imports. The objectives of the study were to establish the descriptive link between exchange rate movements and imports and to determine the causal nexus between exchange rate volatility and import of goods in Uganda. The empirical results show that there was one co-integration equation showing the long run relationship amongst exchange rate movements, real GDP, TOT and exchange rate volatility. The findings further revealed that exchange rate movements had a negative and insignificant effect on imports in the long run and exchange rate volatility depressed imports. The coefficient of one period lag residual was negative and significant which represented the long run equilibrium. The coefficient was -0.51 meaning that system corrected its previous period disequilibrium at a speed of 51% quarterly to reach at the steady state. It further revealed a Uni-directional causal relationship between exchange rate volatility and imports. The study recommends that policy makers in Uganda should consider exchange rate policies as a long-run fix to the problem of growth in foreign goods demand since exchange rate volatility was found to have significant effect on Uganda‟s demand for foreign goods in the long run.
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    Effect of external debt on economic growth in Uganda: 1986 - 2013
    (Makerere University, 2017) Owomugisha, Giliphine
    This study investigated whether external debt affected economic growth in Uganda for the period 1986 to 2013 or not. Quarterly data was used and 112 data points were used for analysis. The log-log model was used to ascertain the effect of external debt on economic growth. This study employed ordinary least squares approach, Vector Error Correction Model and Granger causality test for analyzing long and short-run relationships in addition to causal nexus among the selected variables. These variables included; real GDP which was a proxy for economic growth, external debt stock, debt service payments, exports and imports of goods and services, gross domestic savings, gross capital formation, gross national expenditure and final house hold consumption expenditure which were obtained from World Bank Development indictors. The results revealed that all the study variables except debt service payments and gross domestic savings exhibited their priori signs and were all statistically significant at the 5 percent level. From 1992 after a structural change in the economy, external debt stock, imports of goods and services and gross domestic savings negatively affected economic growth while the coefficients of debt service payments, exports of goods and services, gross national expenditure, gross capital formation and household final consumption expenditure were positive. For the period before the structural break, all study variables were insignificant except from gross domestic savings. It was however found that there was a uni-directional relationship between external debt stock and economic growth. Moreover, it was established that while external debt stock and economic growth may drift apart in the short-run, the disequilibrium between the variables adjusted at about 3 percent towards their long-run equilibrium quarterly. Therefore, the study recommended that since external debts negatively affect economic growth, then with regard to PDM 2013, external borrowing should be primarily focused on productive sectors that boast export growth and those interventions that will enhance productivity in the economy without any deviation. This will be done by aiming at borrowing for highly productive fixed capital investments.
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    Effect of inflation on interest rates in Uganda (2000-2014)
    Erionu, Daniel
    This study concentrated on the effect of inflation on interest rates as the main objective, it covered the period 2000 to 20014. The approaches used was the ordinary least squares for the long-run effect, the error correction model for short run effect and Engle and Granger causality test for the long-run causal effect between the variables. The variables were; interest rates, inflation, gross savings, real exchange rate, gross fixed capital formation and gross national expenditure. The findings show that inflation had a positive significant effect on interest rates at 5% level of significance with a coefficient of 0.004, while gross fixed capital formation had a negative significant effect on interest rates at the same level of significance with a coefficient of -0.004. Conversely gross savings, real exchange rates and gross national expenditure had no significantly effect on interest rates. Results from the short-run model reveal that the Error Correction Term in the model is significant at 1 percent level of significance with a coefficient of -0.13. The Error Correction Term coefficient implied that in each period, the interest rate adjusts between the current level and the long run equilibrium level. The Granger-causality tests reveal that interest rate does not granger-cause inflation rate, but rather inflation rate Granger-cause interest rate. Thus, the direction of the relationship between inflation and interest rate runs from inflation to interest rate. The results from this study identify policy implications for reducing the lending rates and improving the financial sector performance. The study recommends that in controlling the interest rates, the Central Bank through inflation targeting monetary policy framework alone is not enough as evidence suggests that the gross fixed capital formation is also an important determinant of interest rates in Uganda. Therefore, policy makers must expand the variables they need to control for the interest rates to include gross fixed capital formation in order for interest rates to be kept at levels that can encourage borrowing.
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    Effect of remittances on exchange rate volatility in Uganda
    (Makerere University, 2018) Kasabiti, Christine
    The objective of this study was to examine the effect of Remittances on Exchange Rate Volatility in Uganda for the period of 1999 to 2013. Quarterly data was employed. In order to confirm that the variables were stationary, Unit root tests such as ADF, PP and KPSS were employed. The ADF, PP and KPSS tests confirmed that Exchange rate volatility, Remittances and Trade Openness where not stationary at levels but became stationary after taking their first differences. Interest rates, on the other hand, became stationary in levels. Using the Lag Order selection criteria based on the maximum value of the Likelihood ratio function, a Vector Auto Regressive (VAR) structure with 2 lags was confirmed. Johansen cointegration tests based on Maximum Eigen test (P-value of 0.018) and Trace test (P-value of 0.009) confirmed a unidirectional relationship between the variables under study. Results from the long run model indicated a significant relationship between the variables (p=0.000). Furthermore, an Error Correction Model was estimated to examine short run dynamics of the Exchange Rate Volatility. Results from the short run model indicated that 51.3% of the variations in Exchange rate were explained by Trade openness and Interest rates. The coefficient value on remittances was positive but insignificant. Analysis was also carried out to find out the contribution of variables to shocks in the Exchange Rates. Variations in exchange rate volatility were explained by itself at 71.50%, Remittances at 12.38%, Trade openness at 8.94% and Interest rates at 7.156%. Therefore, study findings recommended that policy and decision makers need to pay attention to exchange rate stability and in order to achieve this, macroeconomic fundamentals have to be controlled.
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    The effect of Uganda Women Entrepreneurship Programme on the welfare of beneficiaries: A case of Nansana Municipal Council
    (Makerere University, 2017-12-12) Nansereko, Victoria Ritah
    This study investigates the effect of the Uganda Women Entrepreneurship Programme on the welfare of beneficiaries in Nansana municipal council, Wakiso district. Three out of the four divisions within the municipal were considered for this research. Specifically, the study was conducted in the divisions of Nansana, Nabweru and Busukuma considering a sample of 78UWEP women entrepreneurs out of the 352.Specific objectives for this paper were: to establish the effect of UWEP on business growth, to assess the effect of UWEP on social welfare of its beneficiaries and to ascertain major challenges faced by the women entrepreneurs in Nansana municipality. The study involved use of both qualitative and quantitative methods and data was collected using face-to-face questionnaires. Data was analyzed using both descriptive and inferential statistics. The results showed that there was a significant positive relationship between the UWEP devolving fund and business growth in terms of average monthly sale revenue, average monthly profits and number of employees. Findings showed further that UWEP interventions had improved the socio welfare of the women entrepreneurs in terms of children’s education and acquiring basic household assets. It was also found out that most of the women benefiting from the programme had completed secondary education and thus funds were not going to the most vulnerable women. Despite the benefits of the UWEP programme, major challenges like inadequate funding, large group numbers and some group members not wanting to repay the loan, too much paperwork required and lack of business management skills were put forward by the women entrepreneurs interviewed. However, this paper recommends that the programme funding is increased, creation of incubation centers for mentorship and skills training conducted to enable realization of the pre-set programme objectives.
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    Exposure to risky sexual behaviour among people living with HIV in Uganda
    (Makerere University, 2018-12-16) Musinguzi, Florence
    The objective of this study was to assess the factors associated with exposure to risky sexual behavior among women living with HIV in Uganda. Secondary data was sourced from the 2011 Uganda AIDS indicator survey (UAIS) that comprised of 387 individual records who tested HIV positive in Uganda. The independent variables used in analysis were age, sex of the household head, education level attained, religion, marital status, residence, wealth index age at first sex, recent sexual activity, having multiple sexual partners, currently pregnant, knowledge of reduce risk of getting HIV: always use condoms during sex, and respondent can ask partner to use a condom. The Analysis was done using frequency distribution, Chi-square statistics and binary logistic regression. In the results, close to every three in ten respondents (27.8%) had ever used a condom during the last sexual intercourse. The factors that were significantly associated with condom use were: age (OR=0.09, p-value= 0.005), marital status (OR=0.18, p-value=0.039) and wealth index(OR=2.24, p-value=0.029) since p < 0.05. In particular, condom use is less likely among PLWHAs in the age group 25 to 29 years against those less or equal to 24 years, married women compared to the never married women. On the other hand, the rich women were more likely to use a condom during sex with their most recent sexual partner compared to the poor women. The findings indicate the need to (i) educate people on the importance of condom use and this can be done using newspapers, radios and television and also promote HIV knowledge especially among the poor and women aged less than 30 years.
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    Factors affecting time to remission of Kaposi's Sarcoma patients in Uganda
    (Makerere University, 2018-12-12) Lukungu, Bashir
    ABSTRACT The objective of this study was to investigate the factors associated with Time to Remission of Kaposi’s sarcoma. The assessment was made by socio-demographic characteristics of patients, clinical conditions of patients and type of treatment administered. Administrative records of 354 patients admitted to the Uganda Cancer Institute, Mulago Hospital, between 2010 and 2017 were used in the assessment. The analysis was done using a time-to-event analysis using Kaplan Meier Survival functions and Accelerated Failure Time model. In the results, the median Remission time of patients who had attained remission by the time of the study (N = 170) was 104 weeks (range, 1-344) after admission. In the multiple regression analysis – using the weibull regression –significant variation in remission time of patients were noted by sex of patient, residential status, type of tumor, Cytopenias, Viral load, CD4 count and treatment received (p < 0.05). Particularly, remission time was shorter among the male than females, those whose CD4 count was low had a longer time to remission compared to those with higher CD4 count. In conclusion, the determinants of remission time of patients with Kaposi’s sarcoma in Uganda are place of residence of patient, sex of patient, type of Cytopenias, type of tumor, viral load copies at admission and CD4 count of the patient at admission and treatment. The study recommended three major aspects to help in accelerating time to remission of patients with Kaposi’s sarcoma: i. Mechanism put in place to enhance routine screening for underlying health conditions for Kaposi’s sarcoma patients ii. The need for a routine checkup for viral load and CD4 as it was revealed that patients with better viral load and CD4 counter had shorter time to remission. iii. Set-up treatment centres for cancer medication in the whole country.
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    The Impact of inflation on financial sector development in Uganda, 1980-2014
    (Makerere University, 2018-08) Akena, Geoffrey Oyoo
    This dissertation sets out to empirically determine the relationship between inflation and financial sector development as well as the threshold level of inflation in Uganda. The study adopts annual time series data spanning over the period 1980 to 2014 and the variables used are; Inflation rate (CPI), GDP, Government Expenditure as a percentage of GDP, Trade Openness, Investment as a percentage of GDP. M2 and Domestic Credits to Private Sector (DCPS) were used to proxy financial sector development. The econometric technique used is the Autoregressive Distributing Lags (ARDL) model bound testing approach developed by Pesaran, Shin and Smith (2001). The model was later adjusted to fit the Khan and Senhadji (2001) method to capture the inflation threshold estimation. The finding established a statistically negative long run relationship between inflation and financial sector development in Uganda. The coefficients of the Error Correction Terms (ECM) tells us that the rate of adjustment of the variables from short run to long run occurs at about 58 percent and 61 percent per year when DCPS and M2 respectively are used to proxy financial sector development. It has also been established that, financial sector development will drop by 0.013 when inflation increases by 1 percent when DCPS was used and 0.076 when M2 was used. The results also show that the inflation threshold level occurs at 4 percent. At inflation levels below 4 percent there is a positive but statistically insignificant relationship between inflation and FSD. Beyond 4 percent the relationship becomes negative and the intensity increases exponentially as the inflation rates increases. The main policy recommendation is therefore that, the central bank should concentrate on those policies that keep the inflation rate below or at 4-percent threshold for the financial sector to develop.
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    Living alone among older persons in Uganda: Prevalence and associated factors
    Wandera, S.O ; Akinyemi, Joshua Odunayo ; Adedini, Sunday A ; Odimegwu, Clifford ; Ddumba, Isaac
    This study aimed at investigating the prevalence and factors associated with living alone among older persons in Uganda. A secondary analysis of the 2010 Uganda National Household Survey (UNHS) data was conducted. A complementary log-log regression model was used to estimate the association between living alone and demographic, socio-economic and health factors. Nearly one out of ten (9%) older persons lived alone in Uganda. Living alone was associated with being divorced / separated (OR 18.5, 95% CI: 10.3–33.3), being widowed (OR 8.8, 95% CI: 5.1–15.2), advanced age (OR 2.1, 95% CI: 1.4–3.2), residence in western region (OR 0.6, 95% CI: 0.3–0.93), poor wealth status (OR 0.3, 95% CI: 0.2–06), receiving remittances (OR 1.6, 95% CI: 1.1–2.3) and being disabled (OR 1.6, 95% CI: 1.2–2.1). Living alone among older persons did not vary by gender.
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    Survival of Uganda’s HIV positive service men on TB treatment
    ( 2018-10-18) Ndyabambireki, Acleo
    This study aimed at investigating factors associated with the survival of Uganda’s HIV/TB positive service men on TB treatment in the General Military Hospital (GMH), Bombo army barracks. The source of data was from the clinical and laboratory case reports in the files of patients at GMH between January 2009 to December 2011 sample size of 143 patients. The analysis was made using a time-to-event analysis based on the Kaplan-Meier estimate, the Log-rank Chi-square test and Cox-Proportional Hazard Model. The results showed that the survival of the HIV/TB patients on treatment was overall low (most survived up to 20th weeks of the initiation of ART treatment). By area of residence, most of the servicemen treated at the GMH came from barracks found in rural areas (37.8%) followed by those in urban barracks (32.8%) while the least were those from the Peri urban barracks (29.4%). Majority of the patients on treatment in GMH were bed ridden. The survival of the HIV patients in stage 1 and stage 2 was different from those at stage 3 and stage 4 who were at high risk of death compared to those in stages 1 and 2. The survival of the patients with low CD4 of ≤ 200 cell/𝑚�ㅤ3 was different from that of patients with high CD4 of 500cell/𝑚𝑚3, and those were at high risk of death compared to those with high CD4 of 200cell/𝑚𝑚3 ≤ 500cell/𝑚𝑚3. Patients who were bed ridden had lower chances of survival compared to those at working stage of Karnofsky. Furthermore, HIV infected TB patients who were drinking alcohol and were on ART and TB treatment had lower chances of survival compared to those who were not drinking alcohol. Old age is associated with poor survival, whereas being male is associated with better survival. Patients who develop TB prior to start ART their mortality was high with increasing risk of death (52.5%) compared to those who develop TB while on ART (47.5%). It is recommended that reduction of deaths among HIV/TB patients requires early screening, diagnosis, and faster treatment within 3 months to 8 months for TB infection especially for patients on antiretroviral therapy.