Summary
Knowledge for Change is committed to finding sustainable ways of reducing the burden of disease on individuals, families and the public health system. According to the World Bank (2017), nearly half of Ugandans using public health services live in ‘extreme poverty’ and are ‘further impoverished’ by out-of-pocket expenses incurred during hospital stays. Our work on maternal sepsis showed that around half of all infections treated in Fort Portal Regional Referral Hospital were acquired by patients within the health facility itself.
Sepsis is one of the most common causes of death of patients in Uganda and Tanzania. Many infections that lead to sepsis are contracted within health facilities and can be avoided by implementing Infection Prevention and Control (IPC) measures and making relatively small investments in hospital equipment and infrastructure, such as sinks and washing facilities. Aside from sepsis, hospital acquired infections can lead to further health complications, amputations, antimicrobial resistance, extended hospital stays (and associated costs for the hospital and patients) and increased infection risks for hospital staff, family members and local communities. K4C has run several capacity building and infrastructural development projects across multiple health facilities in Uganda and Tanzania, covering various aspects of IPC including hand hygiene, antimicrobial stewardship, provision of Personal Protective Equipment (PPE), improving practice vaginal examination practice and surgical safety techniques.
Main Activities
Over the last 10 years, K4C has provided running water to 28 hospital wards across Uganda, either by fitting new or fixing existing sinks and plumbing systems, and refurbishing toilet facilities. Our hand gel project currently provides completely free and locally manufactured alcohol hand sanitiser to 3 public hospitals in Fort Portal, and we sell it at cost price (not for profit) to other
charities and private health facilities in the area to ensure sustainability. We have purchased various equipment such as autoclaves (for sterilising medical equipment), rubber mattress covers, delivery beds and drugs trolleys and have invested over £50,000 in renovating hospital and health facilities specifically to reduce infection risks.
Most importantly, our professional nursing, medical and midwifery volunteers have provided invaluable training and mentoring for over 700 local staff across 24 health facilities to build their skills and capacity in IPC. Training has covered a wide range of areas including surgical safety (for example implementing the WHO safe surgery checklist), hand hygiene, appropriate cleaning and decontamination of medical equipment, antibiotic prescribing practices, vaginal examination practices, operative techniques (for example transverse c-section) amongst many other areas. Our volunteers have also implemented new and existing policies, protocols and guidelines to further support staff clinical practice.
COVID-19
The COVID-19 pandemic stimulated further investment from K4C focusing on IPC. The pandemic impacted global supply chains of key IPC consumables including alcohol hand gel, gloves and masks which escalated in price in Uganda and were often unavailable. K4C therefore procured 16,000 high quality masks and shipped these to Uganda to support health workers and patients.
We also undertook a detailed study to understand the role that hospital visitors (known as attendants) play both in transmitting infection but also in reducing infection in the patients they care for. This work, co-authored with Dr Mugahi, Commissioner of Reproductive health at the Ugandan Ministry of Health has now been published and is the only study of its kind in the world. As part of this process, K4C made a film to health educate patients and attendants on the post-natal ward about the risks associated with hospital visiting and ways of mitigating these. A TV screen was purchased enabling the film to be shown regularly on the ward along with other health education films.
Related Publications
Our project findings have been disseminated at several conferences and workshops, as well as forming the basis of a publication about Attendants’ Behaviour, which can be accessed (for free) using the link below: