Page 135 - GHES-2-2

Global Health Econ Sustain Improving health of older adults in rural Uganda

KDH mental health nurse specialist (IO) (Bloom et al., if they or their families suspected deficits in any of these
2018). Over this 1-year period, all 52 VHWs received areas. Groups of 20–30 self-selected individuals gathered
training in Rufumbira, the local language. Forty VHWs at designated times at recognized community meeting
were trained by the original team of HB, PB, IM, and IO, points, such as a stone wall, field, or storage building. As
while the remaining 12 were trained by IM and IO. Each reported previously (Bloom et al., 2018), vision screening
training session was supported by a cadre of eight senior utilized an E chart for far vision and tasks such as reading,
VHWs, selected from among their peers to serve as geriatrics sewing, or sorting beans for near vision. Hearing screening
“trainers,” who received specialized instruction as teachers. was conducted using the Whisper Test, while mobility
was assessed using the timed up and go test. Pain was
During this initial round of training, the VHWs evaluated through questionnaires. All village screenings
learned about the seven focus areas of the project, the were co-led by the local VHW and a senior VHW geriatric
screening tests they could implement in each area, and the trainer. Follow-up home visits allowed VHWs to check on
simple therapeutic interventions and referral indications how well and with what benefit interventions were being
associated with each area (Table 1). utilized; these visits were incentivized by stipends and
monitored by supervisors.
2.3. Screening methods
After the initial group screenings for vision, hearing,
2.3.1. Screening for vision, hearing, and mobility/pain and mobility/pain problems, VHWs used data in their
problems
POCRs to monitor which older adults still needed
Village elders over the age of 60 years were initially recruited screening and conducted the screenings and interventions
for vision, hearing, and mobility/pain screening by VHWs during home visits.

Table 1. Six focus areas, screenings, interventions, and beneficiaries
Focus area: Screening test Interventions Beneficiaries
1. Vision • Reading glasses provided in three magnifications • 2,781 screened
• E‑chart: far vision (+1.75, +2.00, and+2.50) • 2,282 received reading glasses
• Bible, needle‑thread, or beans: near • Database of significant myopia for future optometrist referral for
vision glasses with appropriate refraction
• Referral and mobilization for cataract surgery
2. Hearing • Ear exam with inexpensive otoscope and removal of cerumen • 1,542 examined with an otoscope
• Whisper Test (Pirozoo et al., 2003) impaction • 92 listenators
• Trialing/dispensing low‑cost sound magnification “listenators” for • 690 cerumen disimpactions
profound deficits
3. Mobility and pain • Assessment of fall risk and suitability of canes to replace walking stick • 3,585 assessed mobility/fall risk
• Timed Up and Go • Measurement for cane height a • 671 (received) canes
(Podsiadlo & Richardson, 1991) • Provision of canes (locally crafted), instruction on proper use; • 3,450 acetaminophen
• Clinical history and numerical scale • Dispensing acetaminophen (limited quantities) to elders with chronic • 586 acupuncture
pain b
• Selection/referral of elders to local acupuncturists supported by the
program (Howard et al., 2021)
4. Depression • Referral for mental health supervisor’s follow‑up for mild‑moderate • 8 groups: 69 IPT members from
• PHQ‑9 (Gelaye et al., 2013) depression; 8 villages
• IPT peer group counseling, adapted to Kisoro
• Hospital referral for severe depression/suicidality
5. Dementia • Education of family members and caregivers concerning dementia • 6 homes ‑ families of dementia
•‑ SIDSA (Paddick et al., 2015) using Home Talk flipchart patients
6. Isolation/energy • Provision of small but powerful solar lights to elders meeting • 1,746 Solar lights distributed
• Poverty specified criteria, adjudicated and prioritized by VHW and
• Program census supervisor.
• VHW home survey
Notes: Appropriate cane height proved controversial: older adults, used to tall walking sticks, perceived that the prescribed height was too low,
a
especially when going downhill in their typically rocky terrain. Thus, they were given the option of a cane 1 – 2” taller than standard practice would
advise; Almost all older adults have musculoskeletal pain after spending their lives digging in the fields and, for women, carrying heavy loads on their
b
heads. Most are naïve to pain medication; reportedly, 75% of recipients have positive results from this low-cost, well-tolerated drug. VHWs may also
dispense non-steroidal anti-inflammatory drugs (NSAIDs) under clinical supervision.
Abbreviations: PHQ‑9: Patient Health Questionnaire‑9; SIDSA: Six‑Item Dementia Scale for Africa; VHW: Village health worker; IPT: Interpersonal therapy.

Volume 2 Issue 2 (2024) 4 https://doi.org/10.36922/ghes.3000