Browsing by Author "KAMULEGEYA DAVID PETERSON"

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    DEFAULT RATES, ASSOCIATED FACTORS, AND HEALTH WORKER PERCEPTIONS AMONG CHILDREN AGED 6–59 MONTHS IN OUTPATIENT THERAPEUTIC CARE FOR SEVERE ACUTE MALNUTRITION AT GULU REGIONAL REFERRAL HOSPITAL, UGANDA
    (Gulu University, 2025) KAMULEGEYA DAVID PETERSON
    Background: Outpatient Therapeutic Care (OTC) programs are critical for managing uncomplicated severe acute malnutrition (SAM) in children. However, high treatment default rates undermine recovery, particularly in Northern Uganda, where evidence on contributing factors and frontline worker perspectives/experiences remains limited. Objective: To determine the default rates and factors associated with treatment default among children aged 6–59 months enrolled in OTC at Gulu Regional Referral Hospital (GRRH), and to explore health worker experiences and perceptions with the program. Methods: A sequential explanatory mixed-methods design was used. The quantitative phase involved retrospective chart review of 411 child records from the OTC program at GRRH (July 2022–June 2024). Data were extracted from the integrated nutrition register and analysed in STATA 17 using descriptive statistics, bivariate tests, and multivariable logistic regression. The qualitative phase used a phenomenological approach. Semi-structured in-depth interviews were conducted with nine purposively selected health workers. Transcripts were thematically analysed until saturation was reached. Results: Among 411 children, 57.2% were male, 66.2% were under 24 months, over half weighed <7 kg, and 67.6% had non-edematous SAM. The treatment default rate was 24.8%. Bivariate analysis showed significant associations between default and HIV status (p = 0.01), lower admission weight (p = 0.02), and weight <7 kg (p = 0.03), but no variable remained significant in multivariable analysis. Qualitative analysis revealed six thematic domains: program organization, causes of default, consequences, prevention strategies, systemic challenges, and programmatic recommendations. Key causes of default included transport barriers, RUTF stockouts, , staff absenteeism, seasonal agricultural demands, caregiver misinformation, misconceptions, and negligence, caregiver-level challenges (e.g., Domestic violence, family separation, poverty, inadequate social support, and cultural beliefs), and child-level comorbidities (e.g., HIV, TB, cerebral palsy). Conclusion: Outpatient therapeutic care treatment default at GRRH is high and influenced by structural, clinical, and caregiver-related barriers. While no factors were statistically associated with default, qualitative findings highlight the need for decentralization, consistent supplies, and strengthened caregiver support to improve adherence and recovery in OTC.