Namulaba Health Center Project

DRAFT

Namulaba Health Center Project

Annual Report 1 August 2011 to 31 July 2012Date of Report: 12 May 2013Contact Persons:

Director

Chairperson Namulaba CBO NetworkDr Samuel Kalibala

Mrs Margaret KizitoP.O. Box 2598 Kampala, Uganda

Tel +256 751 933 462Uganda Cellphone 256 772 638 540

Kenya Cellphone 254 722 514 371

Skalibala@hotmail.comSource of Funding: Funded by the kindness of Inger and Claes Ortendahl of Arholma in Sweden plus a number of friendsOur friends Claes and Inger during winter in Sweden. Even in this snow, they still think about the hot dusty village of Namulaba.

Introduction

The Namulaba Health Center project is located in an eight-room health center built on a farm in Namulaba village. The project serves the Nagojje sub-county which has a community of about 30,000 people living in about 6,000 households. To reach the project, you turn left at a township called Namataba which is located 35 Km from Kampala, the capital city of Uganda, on your way to Jinja, the source of the River Nile. From Namataba, you drive 8 Km on an earth road to reach Namulaba. The journey from Kampala to Namulaba takes about 1.5 hours by car if the traffic on the highway is light. The project is funded out of the kindness of a Swedish couple, Inger and Claes Ortendahl of Arholma in Sweden since July 2009. Inger and Claes have made a commitment to fund this project for five years. This commitment was made during the birthday of Inger in 2009. They chose to help Namulaba as a way of thanking God for her happiness. On behalf of the community served by this project, we are very grateful to Inger and Claes. Inger and Claes have been joined by a number of friends who contribute to the project especially to the building of the maternity building. The contributors are listed in the vote of thanks at the bottom of this report. They include the 65 residents of Arholma Island, Sweden, where Inger and Claes live as well as other friends of theirs including those living in Germany. We are grateful for these kind hearts. The project was started by the Director (Dr Samuel Kalibala) on his farm land in February 2005. He was prompted by the number of patients who would come to him for help whenever he visited the farm. In February 2007 the project got its first external funding which came from AVERT, a UK based charity. This funding helped with the purchase of equipment and the clinic became operative from June 2007. The project provides a full range of primary health care services at the clinic and in the community. Detailed Report

The Midwives House: Muzadde Center Muzadde Center is the name we gave to the maternity wing of Namulaba Health Center because the word Muzadde means parent. This project is the main highlight of this reporting period. We are grateful to Claes and Inger for extending beyond their original commitment and making extra personal contribution of money to ensure the construction of the midwife house. In addition to the personal contribution, they have gone out of their way to raise money from their 65 neighbors on Arholma Island in Sweden plus other friends in Sweden and Germany. This contribution started at Ingers birthday party in 2009. When she told her neighbors about the Gift she and Claes had given to Namulaba, the neighbors reacted by contributing the equivalent of US $ 2,300. This was the money used to start the foundation of the building. Part of the building is now ready for use and it we started providing antenatal care in December 2011 and had the first baby delivered on 28th March 2012.

Inger and Claes have continued to work hard and raise funds for Namulaba. Please see list of donors at the end of this report. One of the methods Inger has used is to host a tea club and at the end of it, the guests make a small contribution in a cup. In May 2011, we received Swedish Kronna 1120 from the tea club. We are grateful to Claes and Inger Ortendhal; Mrs. Kerstin Lindgren and Family; Ingela rtendah; Kristina and Torbjorn Paulin; Dr Susanne Richert; the Arholma syjunta; and the Family of Jurgen and Hella Richert plus all friends of Namulaba for enabling us to provide the services below to the community of Namulaba. The catchments community for this project is Nagojje sub-county (about 30,000 people) in Mukono District in central Uganda but the project is called Namulaba because this is the name of the village center where the clinic is located. The Tea Club Members, the Arholma Syjunta:

The cup used to collect the contributions:

Muzadde Center Service Statistics December 2011 to July 2012 Ante Natal Care (ANC)

The center opened on December 1st 2011 and in December it received with pregnant women who were attending ante natal care for the first time plus one who had started attending ANC somewhere else. As the figure below shows the attendance has varied from month to month. Overall between December 2011 and July 2012 a total of 53 pregnant women received antenatal care at our center of whom 22 were attending for the first time and 31 were making repeat visits.

The age of gestation on the first ANC visit ranged from 6 weeks of pregnancy to 32 weeks. We certainly want to encourage pregnant women to attend ANC as early as possible and we hope that the availability of this service will encourage this health care seeking behavior.

Labor and Delivery

So far we have had 10 deliveries and as shown in the figure below six of the babies are boys while four of them are girls.

All the babies were heallhty and normal at birth each with an apgar scores of 10 out of 10. The average weight of the babies was 3.18 Kg. The mothers had an average age of 34 years.

Birth Certificates

We have started the process of getting birth certificates for them. Please see below one of the birth certificates:

In Uganda very few children ever get their birth certificates usually because the procedure is too cumbersome and rather expensive for the parents since each birth certificate costs Shs 15,000 (US $6.52). In the Uganda Demographic Health Survey of 2006 only 21.0% of children under five years had their births registered of whom 10.5% did not have a birth certificate, another 6.1% the parents claimed they had birth certifiates but could not show them to the interviewers and interviewers were only able to see birth certificates for 4.4% of the children. We are thus proud that we are giving these children this gift.

Service Statistics for the Main Medical Clinic Aug 2011 to July 2012The clinic operates on Saturdays. On the last Saturday of the month, the main clinic takes place. The staff includes a medical doctor, two clinical officers, two laboratory technicians, two HIV counselors and three nurses. The services provided include primary health care and HIV counseling and testing plus a special youth corner that provides Adolescent Sexual and Reproductive Health (ASRH) services. On the first three Saturdays of the month a nurse operates a community pharmacy which enables community members to purchase medicines for simple illnesses. The pharmacy is managed by the Namulaba Network of Community Based Organizations (CBOs). The money for buying the first stock of medicines was obtained from a local fundraising event that was organized by the CBO Network and attended by the area member of parliament. The medicines are sold at almost cost price and this enables the pharmacy to re-stock its supply. The salary of the nurse is paid by our project. The nurse also examines and treats patients who come seeking care. In addition the nurse provides ante natal care, free of charge. On these Saturdays the clinic is also used as an outreach post for the ministry of health to provide family planning and child immunization services. Summary of Services provided on the main clinic day (August 2011 to July 2012)

1,270 patients received general medical care

287 received HIV counseling and testing at the clinic

461 received testing for malaria

All Clients Seen

The catchments community for this project is Nagojje sub-county (about 30,000 people) in Mukono District in central Uganda but the project is called Namulaba because this is the name of the village center where the clinic is located. Namulaba Health Center operates a free primary health care clinic for all community members on the last Saturday of every month. The information presented here is for 12 months starting from August 2011 to July 2012 because the annual funding cycle of Namulaba starts in August since this is the month when the five year kind gift from Inger and Claes Ortendhal started in the year 2009. Figure-1 shows that the total number of clients seen on every last Saturday of a month varied between 75 patients in September 2011 of whom 34 were males and 41 were females to 148 patients in January 2012 of whom 58 were males and 90 were females. These patients received primary health care in the way of diagnosis and treatment of common illnesses including fevers, diarrheas, worms, skin diseases as well as malaria. The services also included HIV counseling and testing as well as provision of Septrin (Cotrimoxazole) which prevents opportunistic infections in people living with HIV. HIV positive clients needing CD4 testing are sent to Kawolo Hospital together with a community health worker who directs the patient and ensures payment for CD4 testing using funds provided from our health center.

Figure-1: All Clients Seen August 2011 to July 2011.

In figures 1b it is shown that in the 12 months of reporting we saw a total of 1,270 cleints of whom 482 (38%) were males and 788 (62%)were females. Thus females form the majority of our clients.

Figure 1b: All clients by Sex

Distribution of Clients by Type of Service

As shown in figure 1c the majority of clients come for general medical care (1229) and of these 461 (37.5%) are tested for malaria which means that they come complaining of a fever. In Uganda the commonest cause of fever is malaria and hence if a patient is complaining of fever the first disease to test for is malaria. And as is shown later between 31% and 63% of those tested for malaria are found postive depending on the season since malaria is highest in the rainy season. Figure-1c:Distribution of Clients by Service

General Medical Clients

Figure-2 shows the clients who received treatment at the clinic. This excludes those who only received HIV testing and did not receive any treatment.

Figure-2: General Medical Patients

In figure 2a it is shown that the patients who received medical care in the 12 months of reporting were 1,229 of whom 464 (38%) were males and 765 (62%) were females.

Figure 2a: General Medical Clients by Sex

Clients Tested for HIV

We provide HIV counseling and testing to clients who come seeking just that service and to patients who may have other illnesses but also want to be tested for HIV. Figure-3 shows that the total number tested for HIV on the last Saturday of every month varied from 12 in October 2011 to 36 in January 2012 and the same number in April 2012.

Figure-3: Clients Tested for HIV

HIV Positivity

Figure-4 shows that over the twelve months of this report a total of 287 clients of whom 105 were males and 182 were females received HIV testing. Among the males 13 (12%) were HIV positive and among the females 28 (10%) were HIV positive. These figures are higher than the prevalence of HIV in the general population which according to a recent sero-survey is 6.1% among males and 8.3% among females. The reason our figures are higher is because we test many people who come in because of illnesses and hence we are probably catching more HIV positive clients. Figure-4: HIV Positivity

The two figures 4a and 4b show that the representation of males among clients testing postive for HIV (46%)is higher that the proportionof males among those tested (37%). This suggests that our center is attacting more men at risk of HIV than women. This is a positive observation since male involvement in HIV services is generally low in Uganda and other parts of Africa.

Figures 4a HIV Test clients by sex and 4b HIV Positive Clients by Sex

Patients Tested for Malaria

One of the key services we are most proud of providing is the use of a simple microscope to accurately diagnose the killer disease, especially for children, and provide the effective Artemesinin Combined Therapy (ACT) which we believe saves many lives and reduces suffering due to un-diagnosed malaria or poorly treated malaria. We are grateful to the kind gift of Claes and Inger which enables us to provide this cardilac model of care in a rural remote community. Figure-5 shows that the number tested for malaria on the last Saturday of the month varies from 24 in September 2011 to 51 in November 2011.

Figure-5: Patients Tested for Malaria

Malaria Positivity

In figure-6 it is shown that the positivity rate from malaria testing, shown in red, varies by season. The season with the highest percent of positive malaria test is between May to August in the main rainy season. The season with the lowest percent of positive malaria test is in December to February during the dry season. Figure-6: Malaria Positivity

The two figures 6a and 6b shows that the representation of males among those tested for malaria is 34% which is similar to the representation of males among patients testing postive for malaria(37%).

Figures 6a Malaria Test clients by sex and 6b Malaria Positive Clients by Sex

Vote of thanks

The Director and the Chairperson would like, on behalf of the Namulaba community to express their gratitude to Inger and Claes for the five year commitment to fund Namulaba activities. In addition, we are very thankful to the following friends who have made donations to us through Inger and Claes:

Members of the Arholma Syjunta (Arholma Tea club)

Hella and Jrgen Richert from Grnwald Germany Mrs. Kerstin Lindgren and Family of Sundsvall Sweden Ingela rtendahl of Enskededalen Sweden

Kristina and Torbjorn Paulin of Stenhamra Sweden Dr. Susanne Richert of Gauting Germany

We would also like to thank our friends from AVERT UK for the seed funding that enabled us to function during the first year of our project. We are also grateful to the LC1-, LC-2 and LC-3 who have given us unconditional support since the beginning and the District Medical Officers office which continues to provide supervisory support and use of Namulaba as an outreach for childhood immunizations. We are also grateful to all the friends of Namulaba who have visited us and encouraged us to push on. Last but not least, we are grateful to the people of Namulaba as well as the political and religious leaders who have let us join them to work together to make a difference in peoples lives.

Patients are asked to pay Uganda Shillings 1,000 (US $0.43) for the visit. This represents 10% of the actual cost of care. Women, children, adolescents and people living with HIV and those seeking HIV testing are exempted from this fee. Very poor patients who dont belong to these groups are given a waiver based on assessment by the Sister In-Charge.

We apologize the data for the month of June is missing and will be provided in the full report after a recount from the main register at the clinic

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