ORCID Profile
0000-0001-5125-2820
Current Organisation
University of Western Australia
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Anthropology of development | Development studies | Socio-economic development
Publisher: Wiley
Date: 22-02-2023
DOI: 10.1111/CDOE.12850
Abstract: Aboriginal and Torres Strait Islander communities in remote parts of Australia are some of the most underserviced communities in regard to oral health care. These communities rely on volunteer dental programmes such as the Kimberley Dental Team to fill the gaps in care, however, there are no known continuous quality improvement (CQI) frameworks to guide such organizations to ensure that they are delivering high‐quality, community‐centred, culturally appropriate care. This study proposes a CQI framework model for voluntary dental programmes providing care to remote Aboriginal communities. Relevant CQI models wherein the (i) behaviour of interest was quality improvement, and (ii) the health context was volunteer services in Aboriginal communities were identified from the literature. The conceptual models were subsequently augmented using a ‘best fit’ framework and the existing evidence synthesized to develop a CQI framework that aims to guide volunteer dental services to develop local priorities and enhance current dental practice. A cyclical five‐phase model is proposed starting with consultation and moving through the phases of data collection, consideration, collaboration and celebration. This is the first proposed CQI framework for volunteer dental services working with Aboriginal communities. The framework enables volunteers to ensure that the quality of care provided is commensurate with the community needs and informed by community consultation. It is anticipated that future mixed methods research will enable formal evaluation of the 5C model and CQI strategies focusing on oral health among Aboriginal communities.
Publisher: Springer Science and Business Media LLC
Date: 03-2007
Publisher: Oxford University Press (OUP)
Date: 03-2005
DOI: 10.1016/J.TRSTMH.2004.09.008
Abstract: The population of Gulu District (northern Uganda) has been severely incapacitated by war, epidemics and social disruption. This study is aimed at describing disease patterns and trends in this area through a retrospective analysis of discharge records for 155205 in-patients of Lacor Hospital in the period 1992-2002. The burden of infectious diseases in childhood is overwhelming, with malaria accounting for the steepest increase in admissions. Admissions for war-related injuries and malnutrition fluctuated with the intensity of the war and the severity of famine. Emerging and re-emerging infections, such as HIV/AIDS, tuberculosis and Ebola, accounted for a heavy disease burden however, there has been a trend for admissions related to HIV/AIDS and tuberculosis to decrease since the implementation of community-based services. Vulnerable groups (infants, children and women) accounted for 79.8% of admissions. Long-term war, population displacement, the collapse of social structures and the breakdown of the health system place people at a much greater risk of persistent, emerging and re-emerging infectious diseases, malnutrition and war-related injuries, shaping the 'disease profile of poverty'. Most of the disease burden results from infectious diseases of childhood, whose occurrence could be dramatically reduced by low-cost and effective preventive and curative interventions.
Publisher: Wiley
Date: 16-05-2021
DOI: 10.1111/JOCN.15849
Abstract: To determine whether the current rural graduate programmes in Western Australia adequately support new graduate nurses transitioning into practice. Graduate nurse's transition to employment is a time of significant change and challenge, often resulting in periods of transition shock. These challenges are magnified in rural areas where graduates have to relocate to commence their career with limited rural nursing experience. Graduate programmes were developed to smooth the transition for university trained bachelor's degree registered nurses into the workforce. Supportive graduate nursing programmes are essential for enabling transition to practice and reduce attrition rates. Longitudinal convergent mixed method parallel design was informed by Duchscher's transition stage model. Thematic analysis was applied to all interviews. COREQ checklist was completed. Descriptive statistics and content analysis were used to analyse the survey responses. New graduates cycled through both transition shock and honeymoon periods on commencement of employment, reporting high levels of satisfaction in simultaneity with signs of transition shock. Satisfaction dropped within 7 months indicating a transition crisis before an adjustment period occurred at the end of their graduate year. Limited resources were highlighted as obstacles to providing adequate support to rural graduate nurses. The honeymoon stage of transition co‐existed with transition shock at the commencement of graduate programmes, which may obscure the need for continuing adequate support. Inadequate and/or a lack of preceptorship was evident throughout the Western Australian rural graduate programmes. Graduate programmes need to be structured but flexible to allow for in idual differences in graduates’ and clinical contexts. Structured but flexible graduate programmes allow for in idual differences in graduates and clinical situations. New graduate nurses would benefit from a break midway through their graduate year to assist and overcome the transition crisis stage. Education of nurses undertaking the preceptor role is required to deliver adequate support to graduate nurses and decrease transition shock.
Publisher: Wiley
Date: 30-01-2018
DOI: 10.1111/JOCN.14211
Abstract: To examine international studies that specifically focus on transition to practice for graduate registered nurses in rural and remote areas. Supportive graduate nursing programmes are essential for enabling nursing graduates' transition to practice and reducing attrition rates. Literature examining support measures for nursing graduates within metropolitan areas is abundant. However, there is a paucity of evidence on effective graduate programmes for rural and remote-based nursing graduates. A systematic approach was used to identify robust research within appropriate electronic databases. Eligible articles were critically reviewed using the Mixed Method Appraisal Tool critical appraisal tool. Eligible articles were thematically analysed using the Braun and Clark approach. Eight articles met the selection criteria for inclusion. Findings revealed that while most graduate nurses survived the transition process, they often felt overwhelmed and abandoned with intense feelings of frustration. Many suffered transition shock and did not feel ready for the role. Socialisation of graduates to the clinical environment was lacking. Support offered in many graduate programmes was ad hoc and unstructured. Senior staff were inadequately supported in their roles as preceptors to assist with the transition. Critical support measures recommended included both debrief sessions and regular one-on-one support. Graduate programmes need to be structured yet flexible to accommodate the needs of rural and remote nurse graduates. Graduates need to be transitioned into practice with decremental support processes for both workloads and education. Preceptors require education on how to mentor before they can provide the appropriate support for graduates. Without these measures in place, a decrease in transition shock may not be possible. Graduate programmes need to be structured yet flexible, including assistance with both clinical skills and socialisation. Senior staff require education before they can adequately support new graduates.
Publisher: SAGE Publications
Date: 04-2002
Publisher: Wiley
Date: 31-05-2012
Publisher: Frontiers Media SA
Date: 07-07-2017
Publisher: Oxford University Press (OUP)
Date: 06-2006
DOI: 10.1016/J.TRSTMH.2005.09.002
Abstract: This study aims at estimating the recent trends in HIV-1 prevalence and the factors associated with infection among pregnant women in the Gulu District of north Uganda, a rural area severely affected by civil strife. In 2000-2003, a total of 4459 antenatal clinic attendees of Lacor Hospital were anonymously tested for HIV-1 infection. The overall and age-specific prevalence did not show any significant trend over time. The age-standardized prevalence slightly declined, from 12.1% in 2000 to 11.3% in 2003. Increased age [20-24 years: adjusted odds ratio (AOR) 1.63 95% CI 1.18-2.25 >or=25 years: AOR 2.56 95% CI 1.91-3.44], residence in urban areas (AOR 1.76 95% CI 1.41-2.18), being unmarried (AOR 1.60 95% CI 1.27-2.01), increased age of partner (25-34 years: AOR 1.87 95% CI 1.29-2.73 >or=35 years: AOR 2.68 95% CI 1.72-4.16), modern occupation of partner (AOR 1.98 95% CI 1.53-2.58), and short time of residence at the current address (AOR 1.36 95% CI 1.05-1.76) were associated with infection. The HIV-1 prevalence in this rural district is high and similar to that observed in urban antenatal clinics, probably reflecting the effect of the last 18 years of civil strife.
Publisher: Springer Science and Business Media LLC
Date: 28-03-2009
DOI: 10.1007/S10461-009-9537-Y
Abstract: With availability of antiretroviral treatments, HIV is increasingly recognised as a chronic disease people live with for many years. This paper critically reviews the current literature on fertility desires and reproductive intentions among people living with HIV/AIDS (PLHIV) and critiques the theoretical frameworks and methodologies used. A systematic review was conducted using electronic databases: ISI Web of Knowledge, Science Direct, Proquest, Jstor and CINAHL for articles published between 1990 and 2008. The search terms used were fertility desire, pregnancy, HIV, reproductive decision making, reproductive intentions, motherhood, fatherhood and parenthood. Twenty-nine studies were reviewed. Fertility desires were influenced by a myriad of demographic, health, stigma-associated and psychosocial factors. Cultural factors were also important, particularly in Sub-Saharan Africa and Asia. Future research that examines fertility desires among PLHIV should include cultural beliefs and practices in the theoretical framework in order to provide a holistic understanding and to enable development of services that meet the reproductive needs of PLHIV.
Publisher: MDPI AG
Date: 02-05-2020
Abstract: Systems thinking is a mechanism for making sense of complex systems that challenge linear explanations of cause-and-effect. While the prevention and control of sexually transmissible infections (STIs) has been identified as an area that may benefit from systems-level analyses, no review on the subject currently exists. The aim of this study is to conduct a scoping review to identify literature in which systems thinking has been applied to the prevention and control of STIs among adolescent and adult populations. Joanna Briggs Institute guidelines for the conduct of scoping reviews were followed. Five databases were searched for English-language studies published after 2011. A total of n = 6102 studies were screened against inclusion criteria and n = 70 were included in the review. The majority of studies (n = 34) were conducted in African nations. Few studies focused on priority sub-populations, and 93% were focused on HIV (n = 65). The most commonly applied systems thinking method was system dynamics modelling (n = 28). The review highlights areas for future research, including the need for more STI systems thinking studies focused on: (1) migrant and Indigenous populations (2) conditions such as syphilis and (3) innovations such as pre-exposure prophylaxis and at-home testing for HIV. The need for conceptual clarity around ‘systems thinking’ is also highlighted.
Publisher: Informa UK Limited
Date: 14-06-2007
DOI: 10.1080/09540120601087731
Abstract: We investigated factors potentially associated with the uptake of HIV voluntary counselling and testing (VCT), which is the first step in acceding to programmes for the prevention of mother-to-child transmission of HIV infection. For the period 2001-2003, we estimated the VCT uptake among the 12,252 first-time attendees of the Antenatal Clinic (ANC) at Lacor Hospital (Gulu District, North Uganda). Associations between VCT uptake and socio-demographic characteristics and reproductive history were evaluated using log binomial regression models. VCT uptake was 55.6% for the overall study period it increased from 51.0% in 2001 to 58.6% in 2002 and 57.7% in 2003 (P <0.001). Having some education [primary versus none, adjusted prevalence proportion ratio (PPR) =1.05, 95% confidence intervals (CI): 1.00-1.10] and being unmarried (cohabitating, PPR =1.07, 95% CI: 1.03-1.10 single/widowed/ orced, PPR =1.10, 95% CI: 1.03-1.18) were significantly associated with VCT uptake. Associations of borderline significance were found for: recent change of residence, having a partner with a modern occupation, and past use of contraceptives. VCT uptake is still low in this district of North Uganda. Although some socio-demographic factors were found to have been associated with uptake, the associations were weak and not of public-health significance.
Publisher: Wiley
Date: 19-10-2022
DOI: 10.1111/HEX.13613
Abstract: Culturally and Linguistically Diverse (CALD) groups within high‐income countries are at risk of being left behind by the COVID‐19 vaccination rollout. They face both access and attitudinal barriers, including low trust in government and health authorities. To explore perceptions and attitudes towards COVID‐19 vaccination, as well as facilitators, barriers and strategies to promote uptake among CALD residents of Western Australia (WA), where there were almost no COVID‐19 cases for 2 years. Perth, WA's capital, was chosen as the state's study site because most of the state's CALD population lives there. Eleven semistructured in‐depth interviews and three focus groups (with 37 participants) were conducted with CALD residents between August and October 2021. Thematic analysis was conducted, informed by the ‘Capability’, ‘Opportunity’, ‘Motivation’, ‘Behaviour’ model. CALD participants faced barriers including a lack of knowledge about COVID‐19 and the vaccines, low self‐rated English proficiency and education levels, misinformation, passive government communication strategies and limited access to vaccine clinics roviders. They were, however, motivated to vaccinate by the imminent opening of state and international borders, trust in government and healthcare authorities, travel intentions and the desire to protect themselves and others. Despite high levels of trust and significant desire for vaccines among CALD communities in Perth, current strategies were not meeting their needs and the community remains at risk from COVID‐19. Tailored intervention strategies are required to provide knowledge, address misinformation and facilitate access to ensure uptake of COVID‐19 vaccines—including for additional doses—amongst CALD communities. Governments should work with trusted CALD community members to disseminate tailored COVID‐19 vaccine information and adequately translated resources. The Wesfarmers Centre of Vaccines and Infectious Diseases Community Reference Group at Telethon Kids Institute consulted on this project in September 2020 Ishar Multicultural Women's Health Services consulted on and facilitated the focus groups.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2007
Publisher: Medknow
Date: 2010
Publisher: Oxford University Press (OUP)
Date: 09-2007
DOI: 10.1016/J.TRSTMH.2007.03.019
Abstract: To inform our understanding of male and female health care use, we assessed sex differences in hospital admissions by diagnosis and for in-patient mortality using discharge records for 210319 patients admitted to the Lacor Hospital in northern Uganda in the period 1992-2004. These differences were interpreted using a gender framework. The overall number of admissions was similar by sex, yet differences emerged among age groups. In children (0-14 years), malaria was the leading cause of admission, and the distribution of diseases was similar between sexes. Among 15-44 year olds, females had more admissions, overall, and for malaria, cancer and anaemia, in addition to delivery and gynaeco-obstetrical conditions (25.7% of female admissions). Males had more admissions for injuries, liver disease and tuberculosis in the same age group. In older persons (>or=45 years), women had more admissions for cancer, hypertension, malaria and diarrhoea, while, as for the previous age group, males had more admissions for injuries, liver disease and tuberculosis. This study provides insight into sex- and gender-related differences in health. The analysis and documentation of these differences are crucial for improving service delivery and for assessing the achievement of the dual goals of improving health status and reducing health inequalities.
Publisher: Wiley
Date: 29-06-2016
DOI: 10.1111/AJR.12199
Abstract: Undergraduates who undertake rural placements often choose a rural career. Reluctance from universities to send students to rural settings limits placement numbers. The Western Australian Centre for Rural Health (WACRH) invited allied health and nursing academics and clinical placement coordinators from Western Australian (WA) universities to an Academic Bush C . Based on situated learning theory, this c modelled student programs through experiential learning and structured workshops. It aimed to build relationships and showcase innovative rural learning opportunities. To build relationships and showcase innovative rural learning opportunities. An evaluation of a residential c based on situated learning theory. The c stated and finished in Geraldton, WA and was centered in Mt Magnet, WA a remote town 600 kilometres northeast of Perth. WACRH invited allied health and nursing academics and clinical placement coordinators from Western Australian (WA) universities. This c modelled student programs through experiential learning and structured workshops. Online pre- and post-c questionnaires included open-ended questions and questions on a 5-point Likert scale. Responses were analysed in SPSS 22 using descriptive statistics and Wilcoxon signed-rank test. Follow-up phone interviews six months later assessed longer-term reflections and changes in student placement practice. The main outcome measure was whether the c met participants' expectations, and their knowledge about and interest in WACRH's programs. Twelve academics from five WA universities and seven health disciplines attended. Nine had previously lived or worked rurally. The c met participants' expectations and all would recommend the opportunity to a colleague. Many valued the interaction with community and clinical placement partners and would have preferred more of this. The c increased awareness of WACRH's programs and benefits of longer rural placements and a service-learning environment. Six months later, participants' familiarity with WACRH's placement model, supports and staff had led to an enhanced willingness to place students. Rural academics can influence rural placement intentions by demonstrating the infrastructure, learning and academic support available. A c experience increases metropolitan academics' awareness of rural placement programs and willingness to encourage student participation. Participants with rural backgrounds appeared more receptive to rural learning possibilities.
Publisher: Springer Science and Business Media LLC
Date: 27-06-2014
DOI: 10.1007/S10459-013-9467-3
Abstract: Health indicators for rural populations in Australia continue to lag behind those of urban populations and particularly for Indigenous populations who make up a large proportion of people living in rural and remote Australia. Preparation of health practitioners who are adequately prepared to face the 'messy sw s' of rural health practice is a growing challenge. This paper examines the process of learning among health science students from several health disciplines from five Western Australian universities during 'Country Week': a one-week intensive experiential interprofessional education program in rural Western Australia. The paper weaves together strands of transformative theory of learning with findings from staff and student reflections from Country Week to explore how facilitated learning in situ can work to produce practitioners better prepared for rural health practice.
Publisher: MDPI AG
Date: 27-09-2019
Abstract: Aboriginal and Torres Strait Islander women have significantly higher cervical cancer incidence and mortality than other Australian women. In this study, we assessed the documented delivery of cervical screening for women attending Indigenous Primary Health Care (PHC) centres across Australia and identified service-level factors associated with between-centre variation in screening coverage. We analysed 3801 clinical audit records for PHC clients aged 20–64 years from 135 Indigenous PHC centres participating in the Audit for Best Practice in Chronic Disease (ABCD) continuous quality improvement (CQI) program across five Australian states/territories during 2005 to 2014. Multilevel logistic regression models were used to identify service-level factors associated with screening, while accounting for differences in client-level factors. There was substantial variation in the proportion of clients who had a documented cervical screen in the previous two years across the participating PHC centres (median 50%, interquartile range (IQR): 29–67%), persisting over years and audit cycle. Centre-level factors explained 40% of the variation client-level factors did not reduce the between-centre variation. Screening coverage was associated with longer time enrolled in the CQI program and very remote location. Indigenous PHC centres play an important role in providing cervical screening to Aboriginal and Torres Strait Islander women. Thus, their leadership is essential to ensure that Australia’s public health commitment to the elimination of cervical cancer includes Aboriginal and Torres Strait Islander women. A sustained commitment to CQI may improve PHC centres delivery of cervical screening however, factors that may impact on service delivery, such as organisational, geographical and environmental factors, warrant further investigation.
Publisher: European Respiratory Society (ERS)
Date: 08-03-2023
DOI: 10.1183/16000617.0229-2022
Abstract: Patient-reported outcome measures (PROMs) are recommended for capturing meaningful outcomes in clinical trials. The use of PROMs for children with acute lower respiratory infections (ALRIs) has not been systematically reported. We aimed to identify and characterise patient-reported outcomes and PROMs used in paediatric ALRI studies and summarise their measurement properties. Medline, Embase and Cochrane were searched (until April 2022). Studies that reported on patient-reported outcome (or measure) use or development and included subjects aged years with ALRIs were included. Study, population and patient-reported outcome (or measure) characteristics were extracted. Of 2793 articles identified, 18 met inclusion criteria, including 12 PROMs. Two disease-specific PROMs were used in settings in which they had been validated. The Canadian Acute Respiratory Illness and Flu Scale was the most frequently used disease-specific PROM (five studies). The EuroQol-Five Dimensions-Youth system was the most frequently used generic PROM (two studies). There was considerable heterogeneity in validation methods. The outcome measures identified in this review lack validation for young children and none involve sufficient content validity for use with First Nations children. There is an urgent need for PROM development that considers the populations in which the burden of ALRI predominates.
Publisher: BMJ Publishing Group Ltd
Date: 03-2021
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/PY17148
Abstract: Integration of public health and primary healthcare (PHC) is a hallmark of comprehensive PHC to reduce inequitable rates of preventable diseases in communities at risk. In the context of a syphilis outbreak among Indigenous people in Northern Australia, the association between PHC clinic factors and syphilis testing performance (STP) was examined to produce empirical insights for service managers. Data from the Audit and Best Practice for Chronic Disease National Program (2012–14) were analysed to examine associations between clinic factors and STP (proportion of clients ≥15 years who were tested for or offered a test for syphilis in the prior 24 months). Univariate analyses were conducted for 77 clinics and a subset of 67 remote clinics. Multivariate linear regression models were used to determine independent predictors of STP. Syphilis testing performance across PHC clinics ranged from 0 to 93.8% (median 46.5%). In univariate analysis, Delivery system design, which refers to clinic infrastructure, staffing profile and allocation of roles and responsibilities, was significantly associated with higher STP in all clinics (P=0.004) and in the subset of remote clinics (P=0.008). Syphilis testing performance was higher in the Northern Territory compared to other states, in remote clinics and clinics serving smaller populations. In multivariate analysis, Delivery system design and jurisdiction remained associated with STP. To better realise the potential of comprehensive PHC, service managers should focus on PHC delivery system design to enhance the current syphilis outbreak response.
Publisher: Springer Science and Business Media LLC
Date: 20-08-2020
DOI: 10.1186/S12913-020-05388-Y
Abstract: Sexually transmissible infection (STI) and blood-borne virus (BBV) diagnoses data are a core component of the Australian National Notifiable Diseases Surveillance System (NNDSS). However, the NNDSS data alone is not enough to understand STI and BBV burden among priority population groups, like Aboriginal and Torres Strait Islander people, because it lacks testing, treatment and management data. Here, we describe the processes involved in establishing a STI and BBV sentinel surveillance network representative of Aboriginal Community-Controlled Health Services (ACCHS)—known as the ATLAS network—to augment the NNDSS and to help us understand the burden of disease due to STI and BBV among Aboriginal and Torres Strait Islander peoples. Researchers invited participation from ACCHS in urban, regional and remote areas clustered in five clinical hubs across four Australian jurisdictions. Participation agreements were developed for each clinical hub and in idual ACCHS. Deidentified electronic medical record (EMR) data relating to STI and BBV testing, treatment and management are collected passively from each ACCHS via the GRHANITE tm data extraction tool. These data are analysed centrally to inform 12 performance measures which are included in regular surveillance reports generated for each ACCHS and clinical hub. The ATLAS network currently includes 29 ACCHS. Regular reports are provided to ACCHS to assess clinical practice and drive continuous quality improvement initiatives internally. Data is also aggregated at the hub, jurisdictional and national level and will be used to inform clinical guidelines and to guide future research questions. The ATLAS infrastructure can be expanded to include other health services and potentially linked to other data sources using GRHANITE. The ATLAS network is an established national surveillance network specific to Aboriginal and Torres Strait Islander peoples. The data collected through the ATLAS network augments the NNDSS and will contribute to improved STI and BBV clinical care, guidelines and policy program-planning.
Publisher: Wiley
Date: 12-03-2020
DOI: 10.1111/JOCN.15234
Abstract: To critically review contemporary transition theories to determine how they apply to the newly qualified graduate registered nurse programmes. Graduate nurse transition to employment is the time of significant change which has resulted in high attrition rates. Graduates are often challenged by their expectation of nursing practice and the reality of the role. The transition from hospital‐based training to university‐based training has resulted in the need for primary employment to commence with graduate/orientation/internship programmes to help support new graduates transition into clinical practice. One transition model, Duchscher's stages of transition theory, utilised three former theories to develop a final model. A narrative critical literature review. The theories selected for the review were Kramer's reality shock theory, Benner's novice to expert theory, Bridges transition theory and Duchscher's stages of transition theory. Duchscher's stages of transition theory reflects the experiences of registered nursing transition into the workforce directly from university. The application of the theory is effective to guide understanding of the current challenges that new graduate nurse's experience today. There is a need for new graduates to complete their university degree as advanced beginners in order to decrease the experience of transition shock and keep pace with rapidly changing demands of the clinical environment. This may be achieved by increasing ward‐based simulation in university education. A theoretical framework can provide a deep understanding of the various stages and processes of transition and enable development of successful programmes. Both universities and hospitals need to adapt their current practice to align with the needs of new graduates due to large student numbers and ongoing systematic advancements to decrease the attrition rate.
Publisher: Public Library of Science (PLoS)
Date: 10-04-2023
DOI: 10.1371/JOURNAL.PONE.0284302
Abstract: Family and domestic violence, encompassing erse behaviours including physical, sexual, emotional and financial abuse, is endemic worldwide and has multiple adverse health and social consequences. Principal drivers include traditional gender values that disempower women. Changing these is a key prevention strategy. In Australia, high-quality national surveys provide data on public perspectives concerning family and domestic violence but may not capture community-level ersity. As part of a project for primary prevention family and domestic violence in outer regional Australia, our aims were to develop and administer a questionnaire-based survey suitable for the local community encompassing knowledge about, attitudes towards, and personal experiences of family and domestic violence, to describe and to investigate the theoretical (factor) structure and local socio-demographic predictors of responses, and to determine the extent to which the survey findings are locally distinctive. The online community survey for local residents (≥15 years), comprised items on respondents’ sociodemographic characteristics plus questions abridged from pre-existing national instruments on knowledge about, attitudes towards, and personal experiences of family and domestic violence. Responses were rake-weighted to correct census-ascertained s le imbalance and investigated using exploratory factor analysis, with sociodemographic predictors determined using multiple linear regression and dominance analysis. Among 914 respondents, males (27.0%), those from age-group extremes, and less-educated persons were underrepresented. Familiarity with erse family and domestic violence behaviours was high among all subgroups. Poorer knowledge of the FDV behaviour continuum and attitudes supporting traditional gender roles and FDV were disproportionately evident among males, older respondents and those with lower education levels. Both the factor structure of extracted composite measures reflecting community perspectives and sociodemographic predictors of responses generally aligned with patterns evident in national data. Local reinforcement of existing nationwide findings on community understanding of and attitudes towards family and domestic violence provides salience for targeted interventions.
Publisher: Wiley
Date: 10-2016
Publisher: Wiley
Date: 02-2006
DOI: 10.1111/J.1365-3156.2005.01554.X
Abstract: To estimate differences in fertility by HIV serostatus and to validate an adjustment method for estimating the HIV prevalence in the general female population using data from an antenatal clinic. We used Cox regression models to retrospectively estimate the age-specific relative fertility (RF) of HIV-positive compared to HIV-negative women among 3314 antenatal clinic attenders in northern Uganda. RF and the age distribution of women in the general female population were used to extrapolate the antenatal clinic-based HIV prevalence. This procedure was indirectly validated by comparing the adjusted estimate with those based on standard adjustment factors derived from general female populations in Uganda and Tanzania. HIV-positive women reported a lower fertility than HIV-negative women [age-adjusted RF=0.83, 95% confidence interval (CI): 0.75-0.93]. Except for girls aged 15-19 (RF=0.96, 95% CI: 0.74-1.24) HIV-positive women in all age groups were less fertile (20-24 year: RF=0.83, 95% CI: 0.67-1.01 25-29 years: RF=0.79, 95% CI: 0.62-1.00 30-49 year: RF=0.79, 95% CI: 0.65-0.96]. Adjusting the antenatal clinic-based HIV prevalence (11.6%) for these differences yields a higher estimate (13.8%) that is lower than those based on standard adjustment factors derived from general female populations (from 14.6% to 17.7%). The age-specific pattern of differential fertility by HIV serostatus derived from antenatal clinic data is consistent with findings from population-based studies conducted in Africa. However, differences in fertility between HIV positive and HIV-negative clients underestimate those in the general female population yielding inaccurate estimates when used to extrapolate the HIV prevalence.
Publisher: Springer Science and Business Media LLC
Date: 20-09-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-05-2005
DOI: 10.1097/01.AIDS.0000168977.51843.D6
Abstract: To validate the use of data from a programme for the prevention of mother-to-child transmission (PMTCT) in estimating HIV-1 prevalence in North Uganda. The study was conducted at St. Mary's Hospital Lacor. We compared the estimated prevalence for 3580 attendees at the antenatal clinic who were selected for anonymous surveillance to that for 6785 pregnant women who agreed to undergo voluntary counselling and testing (VCT) for enrolment in the PMTCT programme. Log-binomial regression models were used to identify the factors associated with both VCT uptake and HIV-1 infection, which could bias the prevalence estimates based on PMTCT data. In 2001-2003, the age-standardized prevalence was similar (11.1% in the anonymous surveillance group and 10.9% in the VCT group). The estimates were also similar when compared for each year tested. Analogously, no important differences were observed in age-specific prevalence. Of the factors associated with HIV-1 infection, only time of residence at current address [prevalence proportion ratio (PPR) = 1.05 95% confidence interval (CI), 1.00-1.10], marital status (PPR = 1.05 95% CI, 1.01-1.10) and partner's occupation (PPR = 1.05 95% CI, 1.01-1.10) were associated with VCT uptake, yet the associations were weak. The prevalence estimated based on the VCT data collected as part of the PMTCT programme could be used for HIV-1 surveillance in North Uganda. At the national level, however, it needs to be evaluated whether PMTCT data could replace, or instead be combined with, the data from sentinel surveillance.
Publisher: BMJ
Date: 09-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2003
DOI: 10.1097/00002030-200302140-00014
Abstract: To evaluate two methods for estimating HIV prevalence among the general female population of reproductive age by adjusting data observed among antenatal clinic (ANC) attendees. We adjusted the HIV prevalence among ANC attendees in Fort Portal (Uganda 1994-1995), Mwanza municipality (Tanzania 1990-1991), rural Mwanza (Tanzania 1991-1993), Mposhi district (Zambia 1994), Chelston (Lusaka, Zambia 1994, 1996 and 1998) and Ndola (Zambia 1998), using firstly a method that accounts for differences in age-specific fertility by HIV serostatus and secondly a method that accounts for differences in HIV prevalence by fertility risk category and parity. The non-adjusted HIV prevalence among ANC attendees underestimates the prevalence among the general female population by 8.0% in Chelston in 1998 and by between 20.7% and 31.9% in all other cases. The adjusted prevalence obtained using the first method underestimates the prevalence among the general female population by about 0.5% in Fort Portal and Mposhi it overestimates that observed in Chelston in 1994 and 1996 by about 3.5%, and that observed in Ndola, urban Mwanza and rural Mwanza, by 6.5%, 10.6% and 12.8%, respectively. The second method (applied for only four sites) provides an overestimate of 7.0% in Chelston in 1994 and an underestimate of 3.8% and 2.1% in Ndola and rural Mwanza, respectively. Both adjustment methods overestimate the 1998 prevalence in Chelston, producing less accurate estimates than the non-adjusted data. The HIV prevalence among women in the general population could be estimated fairly accurately by these methods in settings with mature epidemics.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2003
DOI: 10.1097/00126334-200309010-00009
Abstract: To estimate the disease-specific HIV prevalence in a northern Ugandan hospital and to evaluate the impact of HIV/AIDS on hospital services. HIV serosurvey and analysis of routinely compiled hospital records. The serosurvey was conducted among all 352 patients admitted to the medical ward of the Lacor Hospital in March 1999 (this ward consists of 3 units: general medicine, tuberculosis, and cancer). The impact on hospital services was estimated using the hospital discharge records for all 3447 patients admitted in 1999, in combination with serosurvey data, and was expressed as the percentage of bed-days attributable to HIV-positive patients. The overall HIV prevalence was 42.0% (52.6, 44.6, and 13.2% in the general medicine, tuberculosis, and cancer units, respectively). The disease-specific prevalence ranged from 45-65% for patients with tuberculosis, pneumonia, malaria, and enteritis. HIV-positive patients, compared with HIV-negative patients, had a higher in-hospital mortality (14.6 vs. 3.0%) and a lower average length of stay (41.4 vs. 48.9 days). AIDS cases accounted for 5.0% of hospital admissions, 4.1% of bed-days, and 11.5% of deaths. When considering all HIV-positive patients, these accounted for 37.2% of the bed-days. Knowledge of disease-specific HIV prevalence and of the patterns of HIV-related diseases is crucial for early case management. The impact of HIV-positive patients on hospital services is quite high, accounting for >1/3 of the bed-days in 1999. Providing a continuum of care through inpatient, outpatient, and outreach home care services probably represents the only means of relieving the pressure on overloaded hospitals.
Publisher: Springer Science and Business Media LLC
Date: 15-02-2017
Publisher: Guilford Publications
Date: 06-2011
DOI: 10.1521/AEAP.2011.23.3.193
Abstract: HIV-related stigma continues to persist in several African countries including Uganda. This study quantified the burden of stigma and examined factors associated with stigma among 476 people living with HIV (PLHTV) in Gulu, northern Uganda. Data were collected between February and May 2009 using the HIV/AIDS Stigma Instrument-PLWA. Females more than males, respondents aged above 30 years, and those who had been on antiretroviral therapy for a longer time experienced higher levels of stigma. Verbal abuse and negative self-perception were more common forms of stigma. The association between antiretroviral therapy and stigma suggested that organizational aspects of antiretroviral delivery may lead to stigmatization of PLHIV. Interventions such as counseling of PLHIV, education of health workers and the community would lead to reductions in negative self-perception and verbal abuse and in turn improve the quality of life for PLHIV in northern Uganda.
Start Date: 2023
End Date: 12-2026
Amount: $603,010.00
Funder: Australian Research Council
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