{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T05:36:59Z","timestamp":1784957819163,"version":"3.55.0"},"reference-count":45,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,3,5]],"date-time":"2022-03-05T00:00:00Z","timestamp":1646438400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,3,5]],"date-time":"2022-03-05T00:00:00Z","timestamp":1646438400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The neonatal mortality rate in Uganda has barely changed over the past decades, estimated at 28\/1000 and 27\/1000 live births in 2006 and 2016 respectively. The survivors have a higher risk of developing neurodevelopmental disabilities (NDD) due to brain insults from perinatal complications related to poor quality of health services during pregnancy, around the time of birth, and during the postnatal period. This study aimed to assess health facility readiness to care for high risk newborn babies in order to inform programming that fosters early childhood development in eastern Uganda.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A cross sectional study of 6 hospitals and 10 higher level health centers that offer comprehensive maternal and newborn care was carried out in February 2020 in eastern Uganda. A World Health Organization Service Availability and Readiness Assessment tool (SARA) was adapted and used to assess the health facility readiness to manage maternal and neonatal conditions that are related to NDD. In addition, 201 mothers of high risk newborn babies were interviewed on their satisfaction with health services received. Readiness scores were derived from percentage average facilities with available infrastructure and essential medical commodities to manage neonatal complications. Descriptive statistics were computed for client satisfaction with service provision, and p values used to compare private not for profit to public health facilities.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>There was limited availability in numbers and skilled human resource especially the neonatal nurses. Hospitals and health centers scored least in preterm and hypothermia care, with averages of 38% and 18% respectively. The highest scores were in essential newborn care, with readiness of 78% and 85% for hospitals and health centers, followed by resuscitation at 78% and 77%, respectively. There were no guidelines on positive interaction with newborn babies to foster neurodevelopment. The main cause of admission to neonatal care units was birth asphyxia followed by prematurity, indicative of intrapartum care challenges. The overall client satisfaction with health services was higher in private not for profit facilities at 91% compared to public hospitals at 73%, <jats:italic>p<\/jats:italic>\u2009=\u20090.017.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Health facility readiness was inadequate in management of preterm complications. Efforts should, therefore, be geared to improving availability of inputs and quality of emergency obstetric and newborn care in order to manage high risk newborns and reduce the burden of NDD in this setting.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12913-022-07693-0","type":"journal-article","created":{"date-parts":[[2022,3,5]],"date-time":"2022-03-05T22:02:37Z","timestamp":1646517757000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Health facility readiness to care for high risk newborn babies for early childhood development in eastern Uganda"],"prefix":"10.1186","volume":"22","author":[{"given":"Gertrude","family":"Namazzi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Hildenwall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Ndeezi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Mubiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Nalwadda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelina","family":"Kakooza-Mwesige","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Waiswa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James K.","family":"Tumwine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,3,5]]},"reference":[{"key":"7693_CR1","unstructured":"UN-IGME. Levels and Trends in Child Mortality: Report 2018, Estimates developed by the UN Inter-agency Group for Child Mortality Estimation. http:\/\/www.childmortality.org\/. 2018."},{"key":"7693_CR2","volume-title":"Nurturing care for early childhood development: a framework for helping children survive and thrive to transform health and human potential","author":"WHO U World Bank Group","year":"2018","unstructured":"WHO U World Bank Group. Nurturing care for early childhood development: a framework for helping children survive and thrive to transform health and human potential. Geneva: World Health organization; 2018."},{"issue":"Supplement 1","key":"7693_CR3","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1542\/peds.2007-0043B","volume":"120","author":"PK Maulik","year":"2007","unstructured":"Maulik PK, Darmstadt GL. Childhood disability in low-and middle-income countries: overview of screening, prevention, services, legislation, and epidemiology. Pediatrics. 2007;120(Supplement 1):S1\u201355.","journal-title":"Pediatrics"},{"key":"7693_CR4","unstructured":"Goldstein S, Reynolds CR. Handbook of Neurodevelopmental and Genetic Disorders in Children, 2\/e: Guilford Press; 2010."},{"key":"7693_CR5","volume-title":"Survive and thrive: transforming care for every small and sick newborn","author":"WHO","year":"2019","unstructured":"WHO. Survive and thrive: transforming care for every small and sick newborn. Geneva: World Health Organization; 2019. 2019 9789241515887."},{"key":"7693_CR6","volume-title":"Standards for improving quality of care for small and sick newborns in health facilities","author":"WHO","year":"2020","unstructured":"WHO. Standards for improving quality of care for small and sick newborns in health facilities. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO."},{"issue":"2","key":"7693_CR7","doi-asserted-by":"publisher","first-page":"S7","DOI":"10.1186\/1471-2393-15-S2-S7","volume":"15","author":"SG Moxon","year":"2015","unstructured":"Moxon SG, Lawn JE, Dickson KE, Simen-Kapeu A, Gupta G, Deorari A, et al. Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions. BMC Pregnancy Childbirth. 2015;15(2):S7.","journal-title":"BMC Pregnancy Childbirth"},{"issue":"9940","key":"7693_CR8","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1016\/S0140-6736(14)60792-3","volume":"384","author":"ZA Bhutta","year":"2014","unstructured":"Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? The Lancet. 2014;384(9940):347\u201370.","journal-title":"The Lancet"},{"issue":"9814","key":"7693_CR9","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1016\/S0140-6736(11)61577-8","volume":"379","author":"MK Mwaniki","year":"2012","unstructured":"Mwaniki MK, Atieno M, Lawn JE, Newton CR. Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review. The Lancet. 2012;379(9814):445\u201352.","journal-title":"The Lancet"},{"key":"7693_CR10","volume-title":"Born Too Soon: The Global Action Report on Preterm Birth","author":"March of Dimes P","year":"2012","unstructured":"March of Dimes P, Save the Children, WHO. In: Howson CP, Kinney MV, Lawn JE, editors. Born Too Soon: The Global Action Report on Preterm Birth. Geneva: World Health Organization; 2012."},{"key":"7693_CR11","unstructured":"American Academy of Pediatrics. Helping Babies Breathe http:\/\/www.helpingbabiesbreathe.org\/2013 [cited 2013 June 29, 2013]."},{"issue":"21","key":"7693_CR12","doi-asserted-by":"publisher","first-page":"2028","DOI":"10.1056\/NEJMoa2026486","volume":"384","author":"S Arya","year":"2021","unstructured":"Arya S, Naburi H, Kawaza K, Newton S, Anyabolu CH, Bergman N, et al. Immediate\" Kangaroo Mother Care\" and Survival of Infants with Low Birth Weight. N Engl J Med. 2021;384(21):2028\u201338.","journal-title":"N Engl J Med"},{"issue":"1","key":"7693_CR13","doi-asserted-by":"publisher","first-page":"1820714","DOI":"10.1080\/16549716.2020.1820714","volume":"13","author":"G Namazzi","year":"2020","unstructured":"Namazzi G, Tumwine JK, Hildenwall H, Ndeezi G, Mubiri P, Hanson C, et al. Neurodevelopmental outcomes of preterm babies during infancy in Eastern Uganda: a prospective cohort study. Glob Health Action. 2020;13(1):1820714.","journal-title":"Glob Health Action"},{"key":"7693_CR14","doi-asserted-by":"publisher","unstructured":"Kayom VO, Kakuru A, Kiguli S. Newborn Care Practices among Mother-Infant Dyads in Urban Uganda. Int J Pedia. 2015;2015:8. Article ID 815938. https:\/\/doi.org\/10.1155\/2015\/815938.","DOI":"10.1155\/2015\/815938"},{"key":"7693_CR15","doi-asserted-by":"publisher","unstructured":"Aliganyira P, Kerber K, Davy K, Gamache N, Sengendo NH, Bergh A-M. Helping small babies survive: an evaluation of facility-based Kangaroo Mother Care implementation progress in Uganda. Pan Afr Med J. 2014;19:37. https:\/\/doi.org\/10.11604\/pamj.2014.19.37.3928.","DOI":"10.11604\/pamj.2014.19.37.3928"},{"issue":"8","key":"7693_CR16","doi-asserted-by":"publisher","first-page":"e002437","DOI":"10.1136\/bmjgh-2020-002437","volume":"5","author":"S Helfinstein","year":"2020","unstructured":"Helfinstein S, Jain M, Ramesh BM, Blanchard J, Kemp H, Gothalwal V, et al. Facilities are substantially more influential than care providers in the quality of delivery care received: a variance decomposition and clustering analysis in Kenya, Malawi and India. BMJ Global Health. 2020;5(8):e002437.","journal-title":"BMJ Global Health."},{"issue":"12","key":"7693_CR17","doi-asserted-by":"publisher","first-page":"1743","DOI":"10.1001\/jama.1988.03410120089033","volume":"260","author":"A Donabedian","year":"1988","unstructured":"Donabedian A. The quality of care: how can it be assessed? JAMA. 1988;260(12):1743\u20138.","journal-title":"JAMA"},{"issue":"6","key":"7693_CR18","doi-asserted-by":"publisher","first-page":"408","DOI":"10.2471\/BLT.16.175869","volume":"95","author":"ME Kruk","year":"2017","unstructured":"Kruk ME, Chukwuma A, Mbaruku G, Leslie HH. Variation in quality of primary-care services in Kenya, Malawi, Namibia, Rwanda, Senegal, Uganda and the United Republic of Tanzania. Bull World Health Organ. 2017;95(6):408.","journal-title":"Bull World Health Organ"},{"issue":"1","key":"7693_CR19","doi-asserted-by":"publisher","first-page":"24271","DOI":"10.3402\/gha.v8.24271","volume":"8","author":"G Namazzi","year":"2015","unstructured":"Namazzi G, Waiswa P, Nakakeeto M, Nakibuuka VK, Namutamba S, Najjemba M, et al. Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda. Glob Health Action. 2015;8(1):24271.","journal-title":"Glob Health Action"},{"issue":"11","key":"7693_CR20","doi-asserted-by":"publisher","first-page":"e0207156","DOI":"10.1371\/journal.pone.0207156","volume":"13","author":"MC Morgan","year":"2018","unstructured":"Morgan MC, Spindler H, Nambuya H, et al. Clinical cascades as a novel way to assess physical readiness of facilities for the care of small and sick neonates in Kenya and Uganda. PloS one. 2018;13(11):e0207156.","journal-title":"PloS one."},{"issue":"9941","key":"7693_CR21","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1016\/S0140-6736(14)60582-1","volume":"384","author":"KE Dickson","year":"2014","unstructured":"Dickson KE, Simen-Kapeu A, Kinney MV, Huicho L, Vesel L, Lackritz E, et al. Every Newborn: health-systems bottlenecks and strategies to accelerate scale-up in countries. The Lancet. 2014;384(9941):438\u201354.","journal-title":"The Lancet"},{"issue":"Suppl 1","key":"7693_CR22","doi-asserted-by":"publisher","first-page":"i144","DOI":"10.1093\/ije\/dyq031","volume":"39","author":"JE Lawn","year":"2010","unstructured":"Lawn JE, Mwansa-Kambafwile J, Horta BL, Barros FC, Cousens S. \u201cKangaroo mother care\u201d to prevent neonatal deaths due to preterm birth complications. Int J Epidemiol. 2010;39(Suppl 1):i144\u201354.","journal-title":"Int J Epidemiol"},{"key":"7693_CR23","doi-asserted-by":"crossref","unstructured":"Conde-Agudelo A, Belizan JM, Diaz-Rossello J. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev. 2011(3):CD002771.","DOI":"10.1002\/14651858.CD002771.pub2"},{"issue":"1","key":"7693_CR24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s41043-018-0141-5","volume":"37","author":"M Bee","year":"2018","unstructured":"Bee M, Shiroor A, Hill Z. Neonatal care practices in sub-Saharan Africa: a systematic review of quantitative and qualitative data. J Health Popul Nutr. 2018;37(1):1\u201312.","journal-title":"J Health Popul Nutr"},{"key":"7693_CR25","volume-title":"Every newborn: an action plan to end preventable deaths","author":"WHO UNICEF","year":"2014","unstructured":"WHO UNICEF. Every newborn: an action plan to end preventable deaths. Geneva: WHO; 2014. (http:\/\/www.everynewborn.org\/Documents\/Full-action-plan-EN.pdf 2016)."},{"issue":"9941","key":"7693_CR26","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/S0140-6736(14)60750-9","volume":"384","author":"E Mason","year":"2014","unstructured":"Mason E, McDougall L, Lawn JE, Gupta A, Claeson M, Pillay Y, et al. From evidence to action to deliver a healthy start for the next generation. The Lancet. 2014;384(9941):455\u201367.","journal-title":"The Lancet"},{"issue":"6","key":"7693_CR27","doi-asserted-by":"publisher","first-page":"2138","DOI":"10.1542\/peds.2005-1531","volume":"117","author":"ML Ganz","year":"2006","unstructured":"Ganz ML, Tendulkar SA. Mental health care services for children with special health care needs and their family members: prevalence and correlates of unmet needs. Pediatrics. 2006;117(6):2138\u201348.","journal-title":"Pediatrics"},{"issue":"3","key":"7693_CR28","doi-asserted-by":"publisher","first-page":"iii104","DOI":"10.1093\/heapol\/czs045","volume":"27","author":"AK Mbonye","year":"2012","unstructured":"Mbonye AK, Sentongo M, Mukasa GK, Byaruhanga R, Sentumbwe-Mugisa O, Waiswa P, et al. Newborn survival in Uganda: a decade of change and future implications. Health Policy Plan. 2012;27(3):iii104\u201317.","journal-title":"Health Policy Plan"},{"key":"7693_CR29","first-page":"2006","volume-title":"Kampala, Uganda: UBOS and Calverton","author":"UBOS. Uganda Bureau of Statistics (UBOS) and ICF International Inc. 2006. Uganda Demographic and Health Survey","year":"2006","unstructured":"UBOS. Uganda Bureau of Statistics (UBOS) and ICF International Inc. 2006. Uganda Demographic and Health Survey. Kampala, Uganda: UBOS and Calverton. Maryland: ICF International Inc; 2006. p. 2006."},{"key":"7693_CR30","unstructured":"UBOS. Uganda Demographic And Health Survey 2016. Calverton, Maryland, USA: U. B. O. S. U. A. M. Orc., 2016."},{"issue":"1","key":"7693_CR31","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1186\/s12887-019-1769-z","volume":"19","author":"G Namazzi","year":"2019","unstructured":"Namazzi G, Hildenwall H, Mubiri P, Hanson C, Nalwadda C, Nampijja M, et al. Prevalence and associated factors of neurodevelopmental disability among infants in eastern Uganda: a population based study. BMC Pediatr. 2019;19(1):379.","journal-title":"BMC Pediatr"},{"key":"7693_CR32","unstructured":"MUCHAP. Annual Progress Report, 2015. Makerere University Centre for Health & Population Research (MUCHAP) operating Iganga-Mayuge Health Demographic Surveillance Site-Uganda (IMHDSS). Makerere University, 2015."},{"key":"7693_CR33","unstructured":"MoH. National health facility master list. A complete list of all health facilities in Uganda. Kampala, Uganda: Division of Health Information, Ministry of Health, Uganda 2017."},{"issue":"8","key":"7693_CR34","doi-asserted-by":"publisher","first-page":"e1061","DOI":"10.1016\/S2214-109X(20)30232-1","volume":"8","author":"D Walker","year":"2020","unstructured":"Walker D, Otieno P, Butrick E, Namazzi G, Achola K, Merai R, et al. Effect of a quality improvement package for intrapartum and immediate newborn care on fresh stillbirth and neonatal mortality among preterm and low-birthweight babies in Kenya and Uganda: a cluster-randomised facility-based trial. Lancet Glob Health. 2020;8(8):e1061\u201370.","journal-title":"Lancet Glob Health"},{"issue":"1","key":"7693_CR35","doi-asserted-by":"publisher","first-page":"010702","DOI":"10.7189\/jogh.08.010702","volume":"8","author":"SG Moxon","year":"2018","unstructured":"Moxon SG, Guenther T, Gabrysch S, Enweronu-Laryea C, Ram PK, Niermeyer S, et al. Service readiness for inpatient care of small and sick newborns: what do we need and what can we measure now? Journal Glob Health. 2018;8(1):010702.","journal-title":"Journal Glob Health"},{"key":"7693_CR36","unstructured":"Peter Waiswa GN, Paul Mubiri, Darius Kajjo,. Preterm Birth Initiative Progress report for 2016. 2016."},{"issue":"1","key":"7693_CR37","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40748-019-0105-9","volume":"5","author":"I Narayanan","year":"2019","unstructured":"Narayanan I, Nsungwa-Sabiti J, Lusyati S, Rohsiswatmo R, Thomas N, Kamalarathnam CN, et al. Facility readiness in low and middle-income countries to address care of high risk\/small and sick newborns. Maternal health, neonatology and perinatology. 2019;5(1):1\u201314.","journal-title":"Maternal health, neonatology and perinatology"},{"issue":"1","key":"7693_CR38","doi-asserted-by":"publisher","first-page":"17","DOI":"10.2165\/00148581-200709010-00003","volume":"9","author":"CT D\u2019Angio","year":"2007","unstructured":"D\u2019Angio CT. Active immunization of premature and low birth-weight infants. Pediatr Drugs. 2007;9(1):17\u201332.","journal-title":"Pediatr Drugs"},{"issue":"2","key":"7693_CR39","doi-asserted-by":"publisher","first-page":"e0212270","DOI":"10.1371\/journal.pone.0212270","volume":"14","author":"OO Malande","year":"2019","unstructured":"Malande OO, Munube D, Afaayo RN, Annet K, Bodo B, Bakainaga A, et al. Barriers to effective uptake and provision of immunization in a rural district in Uganda. PloS one. 2019;14(2):e0212270.","journal-title":"PloS one."},{"key":"7693_CR40","unstructured":"MoH. Uganda National Policy Guidelines for HIV Counselling and Testing Ministry of Health, Uganda, 2005."},{"issue":"8","key":"7693_CR41","first-page":"CD002771","volume":"2016","author":"A Conde\u2010Agudelo","year":"2016","unstructured":"Conde\u2010Agudelo A, D\u00edaz\u2010Rossello JL. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev. 2016;2016(8):CD002771.","journal-title":"Cochrane Database Syst Rev"},{"issue":"6","key":"7693_CR42","doi-asserted-by":"publisher","first-page":"e0213225","DOI":"10.1371\/journal.pone.0213225","volume":"14","author":"QZ Jamali","year":"2019","unstructured":"Jamali QZ, Shah R, Shahid F, Fatima A, Khalsa S, Spacek J, et al. Barriers and enablers for practicing kangaroo mother care (KMC) in rural Sindh, Pakistan. PloS one. 2019;14(6):e0213225.","journal-title":"PloS one."},{"issue":"2","key":"7693_CR43","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1097\/MOP.0000000000000190","volume":"27","author":"J Santos","year":"2015","unstructured":"Santos J, Pearce SE, Stroustrup A. Impact of hospital-based environmental exposures on neurodevelopmental outcomes of preterm infants. Curr Opin Pediatr. 2015;27(2):254.","journal-title":"Curr Opin Pediatr"},{"issue":"1","key":"7693_CR44","doi-asserted-by":"publisher","first-page":"18","DOI":"10.3109\/01443615.2010.533218","volume":"31","author":"K Grady","year":"2011","unstructured":"Grady K, Ameh C, Adegoke A, Kongnyuy E, Dornan J, Falconer T, et al. Improving essential obstetric and newborn care in resource-poor countries. J Obstet Gynaecol. 2011;31(1):18\u201323.","journal-title":"J Obstet Gynaecol"},{"issue":"S1","key":"7693_CR45","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1038\/pr.2013.206","volume":"74","author":"AC Lee","year":"2013","unstructured":"Lee AC, Kozuki N, Blencowe H, Vos T, Bahalim A, Darmstadt GL, et al. Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990. Pediatr Res. 2013;74(S1):50.","journal-title":"Pediatr Res"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-022-07693-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-022-07693-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-022-07693-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,5]],"date-time":"2022-03-05T22:03:28Z","timestamp":1646517808000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-022-07693-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,5]]},"references-count":45,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["7693"],"URL":"https:\/\/doi.org\/10.1186\/s12913-022-07693-0","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,5]]},"assertion":[{"value":"18 August 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 February 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 March 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All methods\u00a0were performed in accordance with the relevant guidelines and regulations<b>.<\/b> This study was approved by the Makerere University School of Health Sciences Research and Ethics Committee (SHSREC Ref: 2017\u2013011), and the Uganda National Council of Science and Technology (Ref. SS4600). Written informed consent was obtained from all study participants.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors declare no conflict of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}}],"article-number":"306"}}