Theses & Dissertations

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Browsing Theses & Dissertations by Author "Acanga, Alfred"

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    Cost-Effectiveness Analysis of adding Tuberculosis Household Contact Investigation on Passive Case Finding Strategy in South Western Uganda
    (Lira University, 2022) Odongo, Dickens; Omech, Benard; Acanga, Alfred
    Background: The standard passive case-finding strategy implemented by most developing countries is inadequate to detect new cases of TB. A household contact investigation is an alternative approach. The study aimed to evaluate the cost-effectiveness of adding household contact investigation (HHCI) to the passive case-finding (PCF) strategy in the Tuberculosis Control Program in southwestern Uganda. Methods: The study utilized decision-analytic modelling and bottom-up costing (ingredients) methods. The study obtained cost and probability estimates from national TB program data, activity costs, published literature, and expert opinions. It was performed from the societal and provider perspectives over 1.5 years across 12 facilities in Ntugamo, Sheema and Rwampara districts. The primary effectiveness measure was the number of the actual TB cases detected (yield) and the number needed to screen (NNS). The TB yield was calculated from the number of patients diagnosed over the screen. The Incremental Cost-Effectiveness Ratio (ICER) was expressed as cost in 2021 US$ per additional TB case detected. Results: The TB screening yields were 0.52% (1496/289140) for HHCI and 5.8% (197/3414) for PCF. HHCI yield among children 0-14Vs. 15+ years (6.2% Vs.5.4%) p=0.04. the yield among PLHIV Vs HIV- negative (15.8% Vs. 5.3%) p=0.03 in HHCI. The PCF yield in men Vs. women (1.12% Vs. 0.28%) p<0.01. this NNS in PCF was 193 (95% CI: 186-294) and 17 (95% CI: 14-22) in HHCI. The unit costs of detecting a TB case were US$ 204.22 for PCF and US$ 315.07 for HHCI. Patient and caregiver costs are five times in PCF than HHCI (US$ 26.37 vs US$ 5.42). Under the study baseline assumption, adding HHCI to PCF strategies was not cost-effective at US$ 3,596.94 per additional case detected. Conclusion: HHCI improves access to TB diagnosis in children 0-14 years and PLHIV; however, PCF improves access to TB diagnosis among men. The unit cost of detecting one TB case in HHCI was higher than in PCF. Adding HHCI to PCF was not cost effective for detecting TB compared to PCF alone. Therefore, PCF remains the ideal and cost-effective strategy for low resource countries like Uganda. Keywords: Cost-Effectiveness, Yield, NNS, Tuberculosis, Household Contact Investigation, Passive Case Finding, Southwestern Uganda.
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    Household’s Willingness to Pay for Improved Solid Waste Collection Services in Lira City, Northern Uganda
    (Lira University, 2022) Apio, Everline; Akello, Anne Ruth; Acanga, Alfred
    Background: Waste management still remains a big challenge in most urban cities in Uganda including Lira City. This poses a great threat to human kind and the environment. Accordingly, household willingness to pay for solid waste services is paramount for better improvement of SWM at the community. Therefore, this study assessed factors influencing household’s willingness to pay for solid waste collection for disposal in Lira City. Methods: To achieve the study objectives, a survey was conducted utilizing a structured questionnaire to collect quantitative data from 585 randomly selected household heads. Key informant interview was conducted with City Environmental Officers, City Clerk, City Division Health Inspectors, Managers of Private Garbage Collecting Companies, Division Drivers and Staff Engaged in Solid Waste Collection and Market Vendors to supplement quantitative data. Descriptive analysis was used to ascertain the solid waste management practices used by the households and to determine the level of willingness to pay for improved waste collection in Lira City by the residents. The factors influencing household’s willingness to pay were analyzed using a binary logistic model. Results: The findings revealed that, 48.12% of the 585 household heads were willing to pay for improved solid waste collection services and the average amount household heads were to pay for improved solid waste collection services was UGX 3012≠ (0.84$) per month, according to the study, education level, occupation, distance to waste collection sites, and awareness of solid waste environmental concerns were all factors that influenced the amount that households were prepared to pay. Recommendations: As a result of the study findings, it was recommended that residents in Lira City be educated about the importance of effective solid waste management. Secondly, a thriving solid waste collection system should be built in the city, lest the environment’s and human population’s health will be jeopardized. Keywords: Household, Willingness to Pay, and Improved Solid Waste Collection Services