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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    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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    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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    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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    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.