By PATRICK JARAMOGI
KAMPALA, Uganda-SHIFTMEDIA- There is lack of shared decision- making among patients who visit health facilities in Uganda, a new study has revealed.
This leads to lack of compliance regarding treatment according to experts.
The fact that over 60% of Uganda’s population depend on underfunded health care system, only compounds the problem.
The study was conducted by a team of students from the School of Medicine, Makerere University College of Health Sciences led by Nuwagaba Julius.
Others who did the study released in March 2021 included: Ronald Olum, Ali Bananyiza, Godfrey Wekha, Meddy Rutayisire, Keneth Kato Agaba, Gaudencia Chekwech, Jalidah Nabukalu, Genevieve Gloria Nanyonjo, Robinah Namagembe, Sylvia Nantongo, Margaret Lubwama, Innocent Besigye, and Sarah Kiguli.
The study was carried out in Kisenyi Health Center IV, one the heavily visited facility in Kampala. As per records, over 10,000 patients visit this facility per month.
In a publication in the Dove Press, Nuwagaba and team carried out interviews on 326 patients majority (66.9%) women.
The findings were rather shocking. Only 7% of the patients knew the name of their consulting doctor, while only 11.3% participated in shared decision making.
The fact that many patients visiting health facilities in Uganda are don’t engage in SDM, makes drug adherence a daunting challenge.
What is apparent is that health professionals are not promoting SDM.
It is very important that shared decision making, patient involvement and information participation is conducted.
What is SDM?
Shared decision making (SDM) is a process where clinicians collaboratively help patients to reach evidence-informed and value-congruent medical decisions.
SDM involves clinicians and patients sharing the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, to achieve informed preferences.
“For proper patient involvement, a patient must be a stakeholder in decision making including expressing opinions and ideas about the different treatment options,” Nuwagaba noted in the published journal.
Research has shown that low patient involvement in decision making in health centers increases not only treatment cost but also the risk of health care complications.
During this era of COVID 19 vaccination, it is important that patients getting any vaccination get to understand the drug being administered on them.
Use of Depo– Provera in Kisoro
The reported use of free Sayana press injection as a means to curb on the population explosion amidst extreme malnutrition and poverty is raising eyebrows.
The jabs being distributed to adolescent mothers in Kisoro Municipality, supported by the Open Health Network is worrying.
Though various studies (https://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archived=11565 have indicated that the use of Depo- Provera decreases immunity, this is ongoing in Kisoro amidst the COVID 19 pandemic. “The drug is making women more prone to contracting STDs, 3.5 times more that those not on Depo. It diminishes body density, leads to weight gains, and higher chances of getting cancer,” notes a lead science researcher based in the US.
Scientists have always advised that for a patient to be involved in decision making of his/her treatment, it’s incumbent upon the doctor to educate the patients about the disease, and educate them regarding the benefits and side effects of the drug being prescribed (informed consent).
“The rights of women are being violated. Every time she is given Depo-Provera/Sayana Press and not told about its side effects, could be fatal,” says Dr. Olwoch James a Ugandan researcher based in Australia.
He notes that every woman needs to be examined by a qualified physician to determine whether or not, the benefits of Depo-Provera outweighs the risks.
Apparently none of the information is being availed to the rural women in Kisoro.
According to the Ugandan laws, informed consent is considered a right, though the Ministry of Health is not considering this regarding the continuous use of Dep-Provera.
Effects of Depo-Provera
So far reports from a study conducted in Kisoro indicates that the use of Depo- Provera is already taking a huge toll on the population. A recent study showed that the expectations of women in Kisoro after taking Depo-Provera was not what they hoped for.
Majority of the women hoped for a cure, or wanted to feel better (62%) wanted an xray or medicine or both https://link.springer.com/article/101007/s11013-018-9604-9
So due to depression, the women are instead given drugs with more side effects. Adverse reaction reported by 1% to 5% of subjects using Depo-Provera contraceptive injections:
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