Background:Like much of Sub-Saharan Africa, Uganda is facing significant maternal and fetal health challenges. Despite the fact that the majority of the Uganda population is rural and the major obstetrical care provider is the midwife, there is a lack of data in the literature regarding rural health facilities’ and midwives’ knowledge of ultrasound technology and perspectives on important maternal health issues such as deficiencies in prenatal services.Methodology:A survey of the current antenatal diagnostic and management capabilities of midwives at 12 rural Ugandan health facilities was performed as part of an international program initiated to provide ultrasound machines and formal training in their use to midwives at antenatal care clinics.Results:The survey revealed that the majority of pregnant women attend less than the recommended minimum of four antenatal care visits. There were significant knowledge deficits in many prenatal conditions that require ultrasound for early diagnosis, such as placenta previa and macrosomia. The cost of providing ultrasound machines and formal training to 12 midwives was $6,888 per powered rural health facility and $8,288 for non-powered rural health facilities in which solar power was required to maintain ultrasound.Conclusions and Global Health Implications:In order to more successfully meet Millennium Development Goal 4 (reduce child mortality), 5 (improve maternal health) and 6 (combat HIV) through decreasing maternal to child transmission of HIV, the primary healthcare provider, which is the midwife in Uganda, must be competent at the diagnosis and management of a wide spectrum of obstetrical challenges. A trained ultrasound-based approach to obstetrical care is a cost effective method to take on these goals.

BackgroundClient satisfaction surveys are important in evaluating quality of the healthcare processes and contribute to health service improvements by assisting health program managers to develop appropriate strategies. The goal of this study was to assess clients' level of satisfaction with services provided by private-not-for-profit member health facilities affiliated to Uganda Protestant Medical Bureau.MethodsThis was a cross-sectional descriptive study using an interviewer-administered questionnaire conducted in 254/278 (91%) of UPMB member health facilities between 27th April and 14th July 2014 among 927 clients. The tool measured ten dimensions of the care-seeking experience namely; health facility access; waiting time; health providers; support staff; rights; payments; facilities and environment; consent; confidentiality; and the overall care seeking experience. Logistic regression was utilised for multivariate analysis.ResultsOverall client satisfaction was found to be high within the UPMB network (84.2%). Most of the client satisfaction dimensions were rated above 70% except payments and rights. There was evidence of association with marital status; single/never married were 3.05 times more likely to be dissatisfied compared to widowed. Clients attending HCIII were less likely to be dissatisfied compared to those attending HCII (OR=0.51, 95% CI: 0.25–1.05). Post-secondary education (OR=1.79; 95% CI 1.01–3.17), being formally employed (OR=2.78, 95% CI: 0.91–8.48) or unemployed (OR=3.34, 95% CI: 1.00–11.17), attendance at a hospital (OR=2.15, 95% CI: 1.36– 3.41) were also associated with high dissatisfaction levels with payments.ConclusionThis study found a high level of satisfaction with services in the UPMB network but recorded low client satisfaction with the dimensions of rights and payments. Health workers should take time to explain rights and entitlement as well as charges levied to clients.

Background: Family planning confers unique benefits including preventing unintended pregnancies, improving maternal and child health outcomes, and increasing women's access to education and economic opportunities. However, Uganda has a low contraceptive prevalence rate of only 30%, and progress in improving maternal and child health outcomes is slow. Objective: This assessment explores community health workers' and facility-based health workers' qualitative perspectives on the use of contraceptives in the Iganga and Kaliro districts in Eastern Central Uganda. Methods: The baseline assessment used a qualitative approach with a focused sample of community-and facility-based health workers aged 20-60 years. Two focus group discussions with Community Health Workers and four key informant interviews with facility-based health workers were conducted. Thematic content analysis was done manually. Results: The main factors influencing contraceptive use in these communities were preference for large families, perceived inadequate knowledge of family planning and fear of side effects, inadequate spousal and family support, male domination and risk of violence, divorce and polygamy, inadequate human resource capacity and low motivation, and user fees. Conclusion:The study findings suggest that there is low use of contraceptives for family planning in the Kaliro and Iganga districts in Uganda. Recommendations include developing a strong focus in exploring policy options to build the capacities of trained health workers to offer long-term methods in order to increase the availability of family planning options. Family planning interventions should increase the availability of contraceptive methods using gender-sensitive strategies, including community mobilization.

Recognizing the health impact of timing and spacing pregnancies, the Sustainable Development Goals call for increased access to family planning globally. While faith-based organizations in Africa provide a significant proportion of health services, family planning service delivery has been limited. This evaluation seeks to assess the effectiveness of implementing a systems approach in strengthening the capacity of Christian Health Associations to provide family planning and increase uptake in their communities.From January 2014 to September 2015, the capacity of three Christian Health Associations in East Africa-Caritas Rwanda, Uganda Catholic Medical Bureau, and Uganda Protestant Medical Bureau-was strengthened with the aims of improving access to women with unmet need and harmonizing faith-based service delivery contributions with their national family planning programs. The key components of this systems approach to family planning included training, supervision, commodity availability, family planning promotion, data collection, and creating a supportive environment. Community-based provision of family planning, including fertility awareness methods, was introduced across intervention sites for the first time. Five hundred forty-seven facility-and community-based providers were trained in family planning, and 393,964 people were reached with family planning information. Uptake of family planning grew substantially in Year 1 (12,691) and Year 2 (19,485) across all Christian Health Associations as compared to the baseline year (3,551). Cumulatively, 32,176 clients took up a method during the intervention, and 43 percent of clients received this service at the community level. According to a provider competency checklist, facility-and community-based providers were able to adequately counsel clients on new fertility awareness methods. Integration of Christian Health Associations into the national family planning strategy improved through participation in routine technical working group meetings, and the Ministries of Health in Rwanda and Uganda recognized them as credible family planning partners. Findings suggest that by strengthening capacity using a systems approach, Christian Health Associations can meaningfully contribute to national and international family planning goals. Increased attention to community-based family planning provision and to mainstreaming family planning service delivery across Christian Health Associations is recommended.

Spillman et al.: O080: Amplification of patient safety and infection prevention systems in southwest uganda: the power of district based in-hospital training. Antimicrobial Resistance and Infection Control 2013 2(Suppl 1):O80.