RESEARCH IN UGANDA
Omni Med's reason for coming to Uganda was research based. Following a directive from the Task Force on the Global Health Care Worker Shortage at the Brookings Institution, Omni Med first came to Uganda in 2008 with the intention of building a program that could utilize international volunteers, partner with the Ministry of Health while making a measurable impact on the health of local villagers. We have accomplished this, and done so while conducting ongoing research every step of the way. We believe that all service programs should measure their program efficacy, not just assume they are doing work that is effective and teaches volunteers about global health inequity.
As of 2019, Omni Med has completed three studies, with additional studies planned and ongoing. The three studies are as follows:
Health-Related Behavioral Changes in Rural Ugandan Villagers Induced by Village Health Teams Trained and Maintained by a Local NGO and US Health Volunteers: A Randomized Prospective Trial
Authors: E O'Neil Jr, B Lough, E Mworozi, Z Tabb
This study was our first clinical trial in Uganda. We spent close to two years planning it, and it took several more years to understand the data, sort through the numerous challenges involved with data collection on the ground in rural Uganda (changing household contacts, unreliable GPS data, etc), but as of June 2017, it is in the final stages of write-up prior to submission for publication.
In brief, we queried 700 households on their health-related behaviors and disease incidence at the study outset. One year later, after implementing the Ministry of Health's VHT program, along with regular VHT maintenance, data collectors from Uganda Chartered Healthnet returned with the same questions. Full details will follow, but the study demonstrated the efficacy of the VHT program and demonstrated a measurable impact that a service model can have on the health of the local population. This is one of the first RCTs (randomized controlled trials) ever done in the service sector. Submission for publication planned in 2017.
Supporting and Retaining Village Health Teams: An Assessment of a Community Health Worker Program in Two Ugandan Districts
Authors: D Mays, E O'Neil Jr, E Mworozi, B Lough, Z Tabb, A Whitlock, E Mutimba, Z Talib
Given the background of an all volunteer VHT program model in Uganda with a history of poor government support, this study set out to ascertain what factors VHTs felt were barriers to their active engagement in the VHT program, and what factors were important to keep them engaged over the long run. This study used surveys of VHTs and interviews with key stakeholders to better understand specific aspects of support for VHTs that promote retention. Study submitted for publication in 2017.
Note: The study was accepted for publication in The International Journal for Equity in Health on July 3, 2017. Congratulations to Danny, the Omni Med staff, and the research team! To read the paper, please go to the following link for a full pdf: http://rdcu.be/ulGQ
The Use of Low Cost Android Tablets to Train Community Health Workers in Mukono, Uganda in the Recognition, Treatment, and Prevention of Pneumonia in Children Under Five: A Prospective Cohort Pilot Study.
Authors J O'Donovan, K Kabali, J Fuld, M Chukhina, T Lovering, E O'Neil Jr
In this study, staff compared standard ICCM (integrated community case management) training for VHTs to manage pneumonia in the standard didactic fashion, or via pre-recorded trainings using Kindle Fire tablets. This modality could prove to be an important means to train community health workers in resource poor settings elsewhere in Uganda and worldwide. Planned submission for publication in 2017.
Note: The study was submitted for publication in PLOS ONE on July 18, 2017.
Ongoing/ Planned Studies
These studies are already underway or planned as of mid 2017.
Enhanced VHT Study: Pilot
The "Enhanced" approach to VHT training and maintenance is something we have piloted at Omni Med over the past few years. Essentially, it starts with the MOH VHT training program, adds in the VHT maintenance program advocated by Dr Deo Sekimpi, and adds in three program elements that combat the three leading killers of children in Uganda and worldwide: Cookstoves (vs pneumonia), protected water source construction (vs diarrhea), and ITN distributions (vs malaria. We will pilot this approach in 2017-2018 measuring specific disease incidence and mortality by incentivizing VHTs to collect data on a weekly, tracking morbidity and mortality as the program intervention rolls through predetermined villages.
Use of Low Cost Android Tablets to Train Community Health Workers in Mukono: Comparison of a Standard MOH Complete ICCM Trainign Program vs Same on Android Tablets
The pilot study above prepared the way for a comprehensive program in which VHTs undergoing the standard MOH ICCM training are compared with VHTs trained by the same uploaded onto low cost android tablets. Grant applications are in and plans underway to complete the android tablet training modules this summer and execute this trial in early 2018.
Enhanced VHT Study
In this trial, we will build on the results of the pilot to measure the impact of the Enhanced VHT model in a much larger region, utilizing a stepped-wedge model. As above, grant applications are in and this study should launch in 2018.
We cover the entire Mukono District and have plans to train many more VHTs in addition to the 1250 we have trained already. Our model to maintain VHTs is unique in Uganda and we cover all basic health areas in this program model. We are also closely partnered with both the National and District VHT Officials. As such, we have a strong impetus to study how best to improve the lives of those in our district, using methods that are both measurable and scalable. We have an ongoing interest in studying how to improve what we are doing and how we can help the MOH improve its VHT program nationally. We also have a keen interest in placing volunteers into situations where they can make a measurable impact, and help us to execute these research trials. We strongly encourage those with in interest in research to join us. We will no doubt conduct many more studies well into the future.
The graphs above and below come from a 2008 USAID study that demonstrates the way lives are saved in the poorest regions. The poorer the region, the more the most basic interventions, like oral rehydration therapy (ORT) for diarrhea, breast feeding, early antibiotics for pneumonia, bed nets (ITNs) and other basic interventions all done by VHTs, save the most lives. Easy to understand how sharing such interventions do not require graduate level medical training. Most of these interventions can be done by trained VHTs, and medical, nursing, public health and undergraduate students with sufficient passion and dedication can, assisted by Omni Med staff, share the knowledge required to save lives.
Above: A Data Collector from Uganda Chartered Healthnet during Omni Med's first RCT; Below: vilages randomized in same trial
Below Left: Jackie Kading MS-1 Wash U, and Elizabeth Nalweyiso instruct VHTs on Tablets; Below Right: Dr Kabali and Elizabeth with a prize-winning poster.