BackgroundLack of access to health and medical education resources for doctors in the developing world is a serious global health problem. In Rwanda, with a population of 11 million, there is only one medical school, hence a shortage in well-trained medical staff. The growth of interactive health technologies has played a role in the improvement of health care in developed countries and has offered alternative ways to offer continuous medical education while improving patient's care. However, low and middle-income countries (LMIC) like Rwanda have struggled to implement medical education technologies adapted to local settings in medical practice and continuing education. Developing a user-centered mobile computing approach for medical and health education programs has potential to bring continuous medical education to doctors in rural and urban areas of Rwanda and influence patient care outcomes.ObjectiveThe aim of this study is to determine user requirements, currently available resources, and perspectives for potential medical education technologies in Rwanda.MethodsInformation baseline and needs assessments data collection were conducted in all 44 district hospitals (DHs) throughout Rwanda. The research team collected qualitative data through interviews with 16 general practitioners working across Rwanda and 97 self-administered online questionnaires for rural areas. Data were collected and analyzed to address two key questions: (1) what are the currently available tools for the use of mobile-based technology for medical education in Rwanda, and (2) what are user's requirements for the creation of a mobile medical education technology in Rwanda?ResultsGeneral practitioners from different hospitals highlighted that none of the available technologies avail local resources such as the Ministry of Health (MOH) clinical treatment guidelines. Considering the number of patients that doctors see in Rwanda, an average of 32 patients per day, there is need for a locally adapted mobile education app that utilizes specific Rwandan medical education resources. Based on our results, we propose a mobile medical education app that could provide many benefits such as rapid decision making with lower error rates, increasing the quality of data management and accessibility, and improving practice efficiency and knowledge. In areas where Internet access is limited, the proposed mobile medical education app would need to run on a mobile device without Internet access.ConclusionsA user-centered design approach was adopted, starting with a needs assessment with representative end users, which provided recommendations for the development of a mobile medical education app specific to Rwanda. Specific app features were identified through the needs assessment and it was evident that there will be future benefits to ongoing incorporation of user-centered design methods to better inform the software development and improve its usability. Results of the user-centered design reported here can inform other medical education technology develo...

BackgroundIn 2016, Uganda became one of few sub-Saharan African countries to implement comprehensive national smoke-free legislation. Since the World Health Organisation recommends Civil Society Organisation’s (CSO) involvement to support compliance with smoke-free laws, we explored CSOs’ perceptions of law implementation in Kampala, Uganda, and the challenges and opportunities for achieving compliance. Since hospitality workers tend to have the greatest level of exposure to second-hand smoke, we focussed on implementation in respect to hospitality venues (bars/pubs and restaurants).MethodsIn August 2016, three months after law implementation, we invited key Kampala-based CSOs to participate in face-to-face semi-structured interviews. Interviews probed participants’ perceptions about law implementation, barriers impeding compliance, opportunities to enhance compliance, and the role of CSOs in supporting law implementation. Interviews were recorded and transcribed. Qualitative content analysis was conducted using the interview transcripts.ResultsFourteen individuals, comprising mainly senior managers from CSOs, participated and reported poor compliance with the smoke-free law in hospitality venues. Respondents noted that contributing factors included low awareness of the law amongst the general public and hospitality staff, limited implementation activities due to scarce resources and lack of coordinated enforcement. Opportunities for improving compliance included capacity building for enforcement agency staff, routine monitoring, rigorous enactment of penalties, and education about the smoke-free law aimed at hospitality venue staff and the general public. Allegations of tobacco industry misinformation were said to have undermined compliance. Civil Society Organisations saw their role as supporting law implementation through education, stakeholder engagement, and evidence-based advocacy.ConclusionsThis study suggests that the process of smoke-free law implementation in Uganda has not aligned with World Health Organisation (WHO) guidelines for implementing smoke-free laws, and highlights that low-income countries may need additional support to enable them to effectively plan for policy implementation and resist industry interference.

Background The COVID-19 pandemic has disrupted health care access in many countries. The aim of this study was to explore factors that influenced access and utilisation of sexual and reproductive health services among Ugandan youths during the COVID-19 pandemic lockdown. Methods This was across-sectional study carried out from April 2020 to May 2020 in Uganda. A questionnaire was administered online to participants aged 18 to 30 years. Subjects were recruited using a snowballing approach. STATA version 14.2 was used for statistical analysis.Results Of 724 participants, 203 (28%) reported that they did not have access to information and/or education concerning sexual and reproductive health (SRH). More than a quarter of the participants (26.9%, n=195) reported that testing and treatment services of sexually transmitted infections were not available during the lockdown. 27.2% could not obtain contraceptive supplies. Access to HIV services and menstrual supplies were also impaired. Lack of transportation was the commonest factor cited as limiting access to SRH services during the lockdown (68.7%), followed by the long distance from home to SRH facilities (55.2%), high cost of services (42.2%) and the curfew (39.1%). Sexually transmitted infections were the commonest SRH problems related to SRH during the lockdown (40.4%) followed by unwanted pregnancy (32.4%) and sexual abuse (32.4%). Marital, educational, and employment status were significantly correlated with the reported experiences of the participants. Conclusion Access to SRH information and services for Ugandan youths was restricted during the COVID-19 lockdown and may have increased the incidence of poor SRH outcomes. Lack of transportation, distance to health facilities, and high cost of services were important limiting factors. The Government and other stakeholders should incorporate SRH among the priority services to be preserved during future outbreaks.

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ObjectiveThis study evaluated knowledge, opinions and compliance related to Uganda’s comprehensive smoke-free law among hospitality venues in Kampala Uganda.DesignThis multi-method study presents cross-sectional findings of the extent of compliance in the early phase of Uganda’s comprehensive smoke-free law (2 months postimplementation; pre-enforcement).SettingBars, pubs and restaurants in Kampala Uganda.Procedure and participantsA two-stage stratified cluster sampling procedure was used to select hospitality sites stratified by all five divisions in Kampala. A total of 222 establishments were selected for the study. One hospitality representative from each of the visited sites agreed to take part in a face-to-face administered questionnaire. A subsample of hospitality venues were randomly selected for tobacco air quality testing (n=108). Data were collected between June and August 2016.Outcome measuresKnowledge and opinions of the smoke-free law among hospitality venue staff and owners. The level of compliance with the smoke-free law in hospitality venues through: (1) systematic objective observations (eg, active smoking, the presence of designated smoking areas, ‘no smoking’ signage) and (2) air quality by measuring the levels of tobacco particulate matter (PM2.5) in both indoor and outdoor venues.ResultsActive smoking was observed in 18% of venues, 31% had visible ‘no smoking’ signage and 47% had visible cigarette remains. Among interviewed respondents, 57% agreed that they had not been adequately informed about the smoke-free law; however, 90% were supportive of the ban. Nearly all respondents (97%) agreed that the law will protect workers’ health, but 32% believed that the law would cause financial losses at their establishment. Indoor PM2.5 levels were hazardous (267.6 µg/m3) in venues that allowed smoking and moderate (29.6 µg/m3) in smoke-free establishments.ConclusionsIn the early phase of Uganda’s smoke-free law, the level of compliance in hospitality venues settings in Kampala was suboptimal. Civil society and the media have strong potential to inform and educate the hospitality industry and smokers of the benefits and requirements of the smoke-free law.