nursesrevision@gmail.com - Nurses Revision

POST ABORTION CARE

Post abortion care (PAC) is an approach aimed at reducing injuries and death resulting from incomplete and unsafe abortions and their related complications. It is a critical component of comprehensive abortion care and includes five essential elements.

Components of PAC:

1. Emergency Treatment of Incomplete Abortion and Life-Threatening Complications:

Immediate medical attention for incomplete abortions and associated complications.
Evacuation of the uterus to prevent further health risks.

2. Post-Abortion Counseling:

Psychological support to help mothers overcome trauma.
Education on recognizing and responding to complications, such as fever, severe hemorrhage, and acute lower abdominal pain (LAP).
Guidance on when to seek medical help if complications arise.

3. Initiation of Post-Abortal Family Planning Counseling and Services:

Education on the rapid return to fertility post-abortion, typically around 10 days.
Information on available family planning methods.
Support and provision of chosen contraceptive methods to prevent future unwanted pregnancies.

4. Integration with the Reproductive Health Care System:

Continuation of post-abortion emergency services within the broader reproductive health care framework.
Access to comprehensive services including STI/HIV screening and cervical cancer prevention.

5. Community Participation in Complication Prevention:

Education of community members on the dangers of abortion complications, such as:

Bleeding
Foul-smelling discharge
Abdominal pain
Fever

Promotion of measures to prevent complications:

Personal hygiene practices
Treatment of STIs
Use of post-abortion family planning methods

IMPORTANCE OF POST ABORTION CARE

Life-saving services: PAC reduces the risk of maternal mortality and morbidity associated with unsafe abortions.
Reduces fertility problems: Helps mitigate long-term reproductive health issues caused by unsafe abortions.
Prevents unwanted pregnancies: Through effective family planning and contraceptive services.
Accessible quality health services: Ensures women have access to necessary health services.
Improves overall health: Enhances the physical, social, spiritual, and psychological well-being of women.
Better referral management: Streamlines the process for accessing advanced medical care.
Encourages proactive health-seeking behavior: Empowers women to seek timely medical assistance.

COMPREHENSIVE ABORTION CARE

Comprehensive abortion care involves the primary, secondary, and tertiary prevention of unsafe abortions and connects abortion care to other reproductive health services.

It aims to minimize and prevent the negative outcomes of an abortion.

Components of Comprehensive Abortion Care:

Prevention of unintended pregnancies:

Sexuality education
Safe sex practices
Contraception and family planning
Emergency contraception
Community involvement

Provision of abortion services to the full extent of the law:

Legal and safe abortion procedures
Medical and surgical options

Post-abortion care, which includes five elements:

Emergency treatment of abortion complications including evacuation of the uterus for incomplete abortion.
Provision of post abortion and family planning counselling.
Provision of family planning methods.
Linkage between abortion care services and other RH services such as STI/HIV prevention and screening for cancer of the cervix
Community involvement.

MANAGEMENT OF ABORTION

(Find detailed management for each in Gynaecology by clicking here)

Triage for abortion patients:

Monitor vital signs (e.g., BP, pulse)
Assess for shock, excessive pain, level of consciousness, general condition, vaginal bleeding, and fever
Resuscitate if necessary before taking history

THREATENED ABORTION:

Admit to the maternity ward for monitoring
Administer medications such as ferrous sulphate, nifedipine, and Nospa
Advise on bed rest and avoid strenuous activities
Follow up in antenatal clinic if bleeding stops; reassess if it persists

INEVITABLE ABORTION:

Hospitalization and medical management
Perform MVA for pregnancy <16 weeks; administer oxytocin or misoprostol for pregnancies >16 weeks
Schedule follow-up and offer PAC

INCOMPLETE ABORTION:

Hospitalization and surgical management
Use forceps for minimal bleeding or MVA for profuse bleeding
Administer oxytocin or misoprostol for pregnancies >16 weeks
Perform PAC before discharge

COMPLETE ABORTION:

Usually, no need for uterine evacuation
Monitor for bleeding and provide PAC
Administer antibiotics before discharge

COMPLICATIONS OF ABORTION

Acute Complications:

Incomplete abortion
Sepsis
Hemorrhage
Uterine perforation
Bowel injury

Long-term Complications:

Chronic pelvic pain
Pelvic inflammatory disease
Tubal blockage and secondary infertility
Ectopic pregnancy
Increased risk of spontaneous abortion or premature delivery in subsequent pregnancies

BARRIERS TO PAC

Knowledge gap among health workers
Inadequate infrastructure and facilities
Insufficient supportive laws and policies
Long distances to health facilities
Lack of necessary equipment
Mandatory waiting periods
High costs of care
Social stigma
Health workers’ refusal based on personal beliefs.

PREVENTION OF ABORTION

Primary Prevention: Avoiding unwanted pregnancies through education and family planning.
Secondary Prevention: Preventing unsafe abortions through access to safe and legal abortion services.
Tertiary Prevention: Managing post-abortion complications and preventing future unsafe abortions through comprehensive PAC.

Strategies for Prevention:

Counseling and universal access to family planning.
Increase availability of safe abortion services as per the law.
Improve quality and accessibility of PAC.
Educate communities about reproductive health and the dangers of unsafe abortion.
Advocate for policy changes to protect women’s reproductive health.
Promote gender equality and decision-making.
Support education for girls and employment for women.
Encourage attendance at antenatal service centers.
Provide social protection for abandoned women.
Offer non-judgmental counseling.
Ensure access to emergency contraceptives.

Detailed Post-Abortion Care (PAC)

Post-abortion care involves several essential elements to ensure the health and well-being of women who have undergone an abortion.

1. Emergency Treatment of Abortion Complications:

Aspiration and Evacuation: For incomplete abortions, the uterus must be evacuated. The method of evacuation depends on the gestational period.

For pregnancies below 12 weeks, Manual Vacuum Aspiration (MVA) is typically used.
For pregnancies below 9 weeks, Misoprostol is used to terminate first-trimester intrauterine pregnancies. The standard dose is 800 micrograms administered orally, sublingually, or vaginally.
Intravenous Fluids and Resuscitation: In cases of shock, administer normal saline (1 liter in 15-20 minutes) and use plasma expanders if available.
Blood Transfusion: Monitor the amount of blood transfused and the patient’s response to treatment.

Manual Vacuum Aspiration (MVA):

Manual Vacuum Aspiration (MVA) is a method of termination of pregnancy where a healthcare provider uses a handheld device (an aspirator) to remove the contents from the uterus using suction undertaken with the patient awake. A narrow tube attached to a syringe is used to empty the womb using aspiration (gentle suction). Local anaesthetic is injected into the cervix (neck of the womb) to minimize discomfort.

Manual Vacuum Aspiration (MVA) is a preferred, appropriate, and cost-effective procedure for managing abortion in low-resource settings. It is particularly effective up to 12 weeks of pregnancy and has been proven highly efficacious in several randomized controlled trials. MVA has largely replaced dilation and curettage (D&C) in many industrialized and other countries.

Preparation:

Prepare the patient, the room, equipment, supplies, and ensure the presence of an assistant.
Select the appropriate size of the cannula based on the gestational age and uterine size.

Requirements for MVA Procedure:

Trolley (Top Shelf):

Trolley (Bottom Shelf):

Bedside Setup:

Sterile MVA set

Casco speculum

Vulsellum uterine sound

Receiver

Bowl of cotton swabs

Sponge holding forceps

Cannula

Lidocaine or bupivacaine

Syringe and needle

KY jelly

Antiseptic lotion

Gumboots

Buckets

Screens

Apron

Procedure for Manual Vacuum Aspiration:

1. Review Indications:

Inevitable abortion before 16 weeks
Incomplete abortion
Molar pregnancy
Delayed postpartum hemorrhage due to retained placental fragments

2. Provide Emotional Support and Encouragement: Ensure the woman feels supported and reassured throughout the procedure.

3. Offer Pain Relief: Administer paracetamol 30 minutes before the procedure or perform a para-cervical block.

4. Prepare the MVA Syringe:

Assemble the syringe, close the pinch valve, and pull back on the plunger until the plunger arms lock.
For molar pregnancy, have three syringes ready. For very early pregnancy, insert the cannula without prior cervical dilation.

5. Administer Oxytocin or Ergometrine: Give oxytocin 10 units IM or ergometrine 0.2 mg IM to firm the myometrium and reduce perforation risk.

6. Perform a Bimanual Pelvic Examination: Re-assess the size and position of the uterus and the conditions of the fornices.

7. Insert Sterile Speculum and Visualize the Cervix: Apply antiseptic solution to the vagina and cervix, especially around the os.

8. Check the Cervix for Tears or Protruding POC: Remove any products of conception (POC) with ring (or sponge) forceps.

9. Gently Grasp the Anterior Lip of the Cervix: Use ring forceps or a single-toothed tenaculum. If using a tenaculum, first inject 1 mL of 0.5% lignocaine solution into the cervix.

10. Dilate the Cervix if Needed: For missed abortion or prolonged retention of POC, use mechanical or osmotic dilators, or cervical priming with mifepristone or prostaglandin.

11. Insert the Cannula: While applying gentle traction to the cervix, insert the cannula through the cervix into the uterine cavity just past the internal os.

12. Attach the Prepared MVA Syringe: Hold the ring forceps or tenaculum and the end of the cannula in one hand and the syringe in the other. Release the pinch valve(s) to transfer the vacuum to the uterine cavity.

13. Evacuate Remaining Contents: Gently rotate the syringe from side to side and move the cannula back and forth within the uterine cavity without losing vacuum.

14. Check for Signs of Completion: Look for red or pink foam without tissue, a grating sensation, and the uterus contracting around the cannula.

15. Withdraw the Cannula: Detach the syringe, place the cannula in decontamination solution, and empty the syringe contents into a strainer.

16. Perform a Bimanual Examination: Check the size and firmness of the uterus post-procedure.

17. Inspect the Tissue Removed: Ensure complete evacuation, assess for molar pregnancy, and if necessary, strain and rinse the tissue for examination.

18. Address Absence of POC: If no POC are seen, consider complete abortion, breakthrough bleeding, or possible ectopic pregnancy.

19. Reinsert Speculum and Examine for Bleeding: If persistent bleeding or soft uterus, repeat evacuation.

Post-Procedure Care: Administer paracetamol 500 mg as needed, consider antibiotics, encourage the woman to eat, drink, and walk, and offer other health services.

Discharge Uncomplicated Cases: Discharge within 1-2 hours, advising on symptoms that require immediate attention.

Precautions for Performing MVA:

Delay the procedure if conditions like shock, severe vaginal bleeding, or intra-abdominal injury are present, and stabilize the patient first.
Stabilization involves oxygen, IV fluids, antibiotics for sepsis, and blood transfusion if needed.

Shock Management:

Rapid, weak pulse, low blood pressure, pallor, sweatiness, rapid breathing, anxiousness, confusion, or unconsciousness.
Treat with oxygen, IV fluids, antibiotics, and blood transfusion if necessary.

Severe Vaginal Bleeding:

Heavy bright red bleeding, pallor, and blood-soaked materials.
Assess all bleeding sources, stabilize, and evacuate POC.

Intra-Abdominal Injury:

Distended abdomen, decreased bowel sounds, rigid abdomen, rebound tenderness, nausea, vomiting, pain, fever, or cramping.
Immediate management with IV fluids, antibiotics, and potential surgery. Perform MVA after stabilization.

POST ABORTION CARE Read More »

CUSTOMER CARE

Customer care refers to the practice that enables an organization to deliver services or products in a way that allows the customer to access them in the most efficient, cost-effective, and humanly satisfying and pleasurable manner possible.

Customer care is when companies treat their customers with respect and kindness and build an emotional connection with them.

The Manifestations Of Good Customer Care

Honesty: Being honest with customers in business transactions, whether with customers, suppliers, financiers, or competitors.
Handling Customers’ Objections and Complaints: Effectively addressing customer objections and complaints, such as issues with underweight or overpriced products, wrong sizes, or contaminated products.
Offering Prompt and Excellent Services: Providing quick and excellent service to customers whenever they show interest or demand goods or services.
Availability: Being available to meet customer demands and assist them at all times.
Listening to Customers: Listening to customer suggestions and opinions to understand their needs and preferences better.
Providing Basic Product Knowledge: Offering basic knowledge to customers about how to use the product effectively.
Pleasant Interaction: Maintaining a pleasant demeanor and attitude when serving customers to create a positive experience.
Technical and After-Sales Services: Offering technical assistance and after-sales services, such as packaging, transportation, and free gifts, to enhance customer satisfaction.
Improving Product Quality: Regularly improving the quality of products based on market demands and customer feedback.
Price Reductions and Discounts: Offering occasional price reductions or discounts to customers to increase customer loyalty and satisfaction.
Providing Credit Facilities: Extending credit facilities to customers who may not have ready cash to facilitate their purchases.
Clear Communication: Ensuring clear and transparent communication with customers to avoid misunderstandings and build trust.

Indicators Of Good Customer Care In Business

Increase in sales and profits due to satisfied customers who are likely to make repeat purchases.
Decrease in advertising costs as satisfied customers are likely to recommend the business to others through word-of-mouth.
Increase in the number of customers attracted to the business due to positive reviews and recommendations.
Repeat purchases by customers who are satisfied with the quality of products and services offered.
Availability of after-sales services and support to address any issues or concerns customers may have.
Use of suggestion boxes to gather feedback from customers and improve products or services.
Offering discounts or promotions to loyal customers as a token of appreciation for their continued patronage.
Honesty and transparency in business transactions to build trust and credibility with customers.

Benefits Of Good Customer Care In Enterprise

Improvement of the business’s image and reputation in the eyes of the public.
Promotion of good relationships between the business and its customers, leading to increased customer loyalty.
Increase in sales revenue due to satisfied customers who are more likely to make repeat purchases and recommend the business to others.
Act as a marketing technique by attracting new customers through positive word-of-mouth and referrals from satisfied customers.
Provide a platform to address and resolve customer complaints and issues promptly, thereby preventing negative publicity.
Help the business outcompete its competitors by offering superior customer service and satisfaction.
Prevention of customers from being exploited or mistreated by unethical business practices.
Retention of existing customers and attraction of new ones through exceptional customer care and service.

Promotion Of Good Customer Relations In A Business

Customer relations refer to the ways in which a business deals with its customers.

Proper handling of customer complaints and queries to ensure prompt resolution of issues and maintain customer satisfaction.
Showing genuine respect and appreciation for individual customers to build positive relationships and trust.
Honesty and transparency in business transactions to build credibility and foster long-term relationships with customers.
Providing prompt services to customers to demonstrate reliability and efficiency in meeting their needs.
Maintaining politeness and using appropriate business language when interacting with customers to create a positive impression.
Demonstrating care and empathy towards customers by addressing their needs and concerns with sincerity and compassion.
Continuous improvement of product quality to meet or exceed customer expectations and enhance their satisfaction.
Offering credit facilities to trustworthy customers to facilitate their purchases and build loyalty.
Providing gifts and samples to customers as tokens of appreciation and to encourage repeat business.
Offering discounts and after-sales services to reward loyal customers and incentivize future purchases.

CUSTOMER SATISFACTION SURVEY

A customer satisfaction survey is a study conducted to determine whether customers are satisfied with a product or service.

Face-to-face interaction to gather direct feedback and insights from customers.
Phone calls to follow up with customers and address any concerns or issues they may have.
Mailed surveys sent to customers to gather their opinions and feedback on their experience with the product or service.
Email surveys distributed to customers to collect their feedback and assess their level of satisfaction.

Measures to Ensure Customer Satisfaction:

Offering good quality products that meet or exceed customer expectations.
Providing timely responses to customer concerns and inquiries to demonstrate responsiveness and care.
Ensuring good packaging of products to protect them during transportation and enhance their presentation.
Charging fair prices or offering discounts to provide value for money and attract price-conscious customers.
Ensuring a constant supply of products to meet customer demand and prevent stockouts.
Being honest and transparent in business dealings to build trust and credibility with customers.
Providing sufficient information about the use of products or services to educate customers and enhance their experience.
Being courteous, sincere, and attentive when interacting with customers to create a positive and memorable experience.
Offering a variety of products or services to cater to diverse customer needs and preferences.
Ensuring clear and effective communication with customers to avoid misunderstandings and build trust.

CUSTOMER CARE Read More »

MARKETING

Marketing management involves the performance of activities necessary to get goods or services from the producer to customers, resulting in customer satisfaction and profits for the entrepreneur.

It includes identifying, anticipating, and satisfying customer needs effectively and profitably.

Marketing is the action or business of promoting and selling of products or services.

Marketing refers to the activities a company undertakes to promote the buying or selling of its products or services.

The main objective of marketing is to ensure that the customer’s needs or wants are satisfied and at the same time enabling the entrepreneur to make profits.

Objectives of Marketing:

To recover cash quickly
To target a new market
To penetrate the market, especially for new products
To increase or maintain market share
For product line promotion
To increase sales revenue and profitability
For functional satisfaction
To maintain or improve the image of products or a business.
To achieve the four utilities: possession, time, form, and place utilities
To develop new products or improve existing products.

Conditions of Exchange:

At least two parties involved
Each party has something of value to the other
Both parties are capable of communication and delivery
Both parties are free to accept or reject the exchange offer
Both parties believe it’s appropriate or desirable to deal with the other

SELLING FUNCTION

Selling is a two-way communication between the buyer and seller, aimed at persuading the buyer to accept a product at a stated price.

It involves informing the customer how the product meets their needs, its price, usage instructions, and benefits.

Differences between Selling and Marketing:

Feature	Marketing	Selling
Focus	Customer needs	Seller needs
Importance	Customer	Product
Approach	Integrated, long-term	Immediate gains
Conversion	Customer needs to product	Product to cash
Emphasis	Customer satisfaction	Sales volume
Orientation	External market	Internal business
Mindset	Customer-oriented	Product-oriented

Marketing focuses on customer’s needs while selling focuses on the seller’s needs: Marketing aims to understand and fulfill customer needs, while selling is focused on meeting sales targets and generating revenue for the seller.
In marketing, a customer enjoys supreme importance, while in selling, the product enjoys supreme importance: Marketing prioritizes customer satisfaction and long-term relationships, whereas selling often prioritizes closing deals and achieving short-term sales targets.
In marketing, there is an integrated approach to achieve long-term goals, while in selling, there is a fragmented approach to achieve immediate gains: Marketing strategies are designed to achieve long-term growth and sustainability, while selling tactics may focus on short-term results without considering broader business objectives.
In marketing, an entrepreneur converts customer needs into a product, while in selling, they convert the product into cash: Marketing involves identifying and developing products that meet customer needs, while selling involves persuading customers to purchase existing products.
In marketing, there is caveat venditor (let the seller be aware), while in selling, there is caveat emptor (let the buyer be aware): Marketing promotes transparency and ethical business practices, while selling may sometimes involve aggressive tactics or incomplete disclosure.
In marketing, profits are realized through customer satisfaction, while in selling, profits are realized through sales volume: Marketing strategies focus on building customer loyalty and repeat business, while selling may prioritize achieving sales targets regardless of customer satisfaction.
Marketing aims at external market orientation, while selling aims at internal business orientation: Marketing strategies are outward-focused, considering market trends and customer preferences, while selling activities are often internally focused on meeting sales quotas and targets.
Marketing is based on a customer approach, while selling is based on a product approach: Marketing starts with understanding customer needs and preferences, while selling starts with promoting the features and benefits of a product.
Marketing is a series of activities an entrepreneur does to find out who his customers are and what they need or want, while selling is a two-way communication between the buyer and seller aimed at persuading the buyer to buy the product: Marketing involves market research, product development, and promotional activities, while selling focuses on direct interaction with customers to close sales transactions.

Marketing Concepts

Marketing concepts refer to the approaches that guide businesses in their marketing activities. These concepts represent different perspectives on how companies should understand and fulfill customer needs, manage their products, and achieve their marketing objectives.

1. Production Concept:

The production concept emerged during the early stages of capitalism until the mid-1950s. Businesses operating under this concept prioritized production, manufacturing, and efficiency. They believed that customers mainly sought products that were affordable and readily available. The core idea behind the production concept is that companies can lower costs and increase supply through mass production, thereby maximizing profits. For example McDonald’s, which revolutionized the fast-food industry by implementing assembly-line production methods to serve customers quickly and affordably.

2. Product Concept:

The product concept operates on the assumption that customers value quality and features above all else, and are willing to pay a premium for superior products. Companies following this concept continuously strive to improve product quality and innovation. A modern example is the technology industry, where companies like Apple and Samsung invest heavily in research and development to enhance product features and performance. Despite higher prices, customers are attracted to these brands for their reputation of offering high-quality products. Another example is luxury fashion brands like Louis Vuitton and Gucci, which focus on crafting premium products with superior craftsmanship and exclusive designs, catering to customers seeking luxury and prestige.

3. Selling Concept:

Unlike the production and product concepts which focus on production and product quality respectively, the selling concept prioritizes making sales regardless of customer needs or product quality. This approach relies on aggressive sales tactics to push products onto customers. For instance, When retailers offer extended warranties on products such as electronics or appliances, they are implementing the selling concept. Rather than emphasizing the quality or suitability of the product for the customer’s needs, the focus is on persuading customers to add an extra layer of protection to their purchase.

4. Marketing Concept:

The marketing concept revolves around putting the consumer at the center of the organization’s activities. It emphasizes understanding and meeting customer needs and wants through market research and customer-centric strategies. An example is Coca-Cola’s marketing strategy, which focuses on creating emotional connections with consumers through storytelling and personalized experiences, leading to brand loyalty and repeat purchases.

5. Societal Marketing Concept:

The societal marketing concept is a relatively new approach that not only considers the needs and wants of target markets but also emphasizes the well-being of society as a whole. In addition to company profits and customer satisfaction, societal marketing incorporates ethical and social considerations into marketing practices. For example, a local supermarket organizing food drives for homeless shelters or sponsoring educational programs for underprivileged children demonstrates a commitment to societal welfare beyond profit generation.

MARKETING MIX

Marketing mix is a combination of factors that can be controlled by a company to influence consumers to purchase its products.

The marketing mix is a strategic framework that consists of four key components, often referred to as the 4 Ps of marketing. These components are product, price, place, and promotion. The marketing mix helps businesses create plans to differentiate their products or services from competitors and create value for customers .

Product:

The product component focuses on the item or service being sold. It should satisfy a consumer’s need or desire.
Questions to consider: What is the product? Does it fulfill a need or provide a unique experience? Who are the target customers? What differentiates the product from the competition?.

Product

A product is anything offered to the market, which can be a good or a service.

Types of Product

Products can be categorized as goods or services:

Goods: Tangible items with utility that are sold by businesses.
Services: Intangible offerings where one party provides something to another, resulting in satisfaction but not ownership. These may include performances, acts, deeds, or efforts.

The Product Life Cycle

The product life cycle refers to the period during which a product remains appealing to customers. Some products last for centuries, while others may only endure for months. Investing in product development and promotion is important to prolonging a brand’s life cycle.

Stages of the Product Life Cycle:

Development: The initial idea is developed and tested, involving significant expenses for the business.
Introduction: The product or service is launched for sale, with slow initial sales as consumer awareness grows through informative advertising.
Growth: Sales start to increase rapidly, requiring persuasive advertising. Profits begin to emerge as revenue surpasses costs, and competition intensifies with new market entrants.
Maturity: Sales growth slows down, and the market becomes saturated with high competition. This stage can endure for years.
Decline: Sales steadily decrease as new products emerge or the product loses its appeal. Eventually, the product may be withdrawn from the market due to low sales and profitability.

Price:

The price component refers to the cost of the product that the consumer pays. It should reflect market trends, be affordable for consumers, and be profitable for the business.
Questions to consider: How much do competitors charge for similar products? What is the affordability and price range of target consumers? What is the best price fit for the target market?.

PRICING OF GOODS AND SERVICES

Pricing refers to the activity of assigning monetary values to goods and services offered by an entrepreneur.

It’s part of business operations as it directly impacts the entrepreneur’s profit and the purchasing power of consumers.

Methods Used By Entrepreneurs When Pricing Their Products:

Penetration Pricing: This involves setting a low price combined with persuasive advertising to capture a large market share quickly. A new streaming service launches with a low introductory price of $5 per month for the first three months to attract a large number of subscribers quickly.
Target Pricing: The firm pre-determines a target level of profits and sets a price to achieve those profits. A clothing company aims for a 20% profit margin on its new line of jeans. They calculate the production cost per pair of jeans and set a price that will achieve their desired profit target.
Skimming Method: Suitable for top-quality versions, targeting a distinct class of customers with higher prices. A luxury car manufacturer releases a limited edition model with a high price tag, targeting wealthy customers who are willing to pay a premium for exclusivity.
Price Discrimination: Charging different prices in different markets for the same good for reasons unrelated to production costs, An airline charges different fares for the same flight depending on the day of the week, time of day, and whether it is booked in advance or last minute.
Auctioning: Prices are determined by the highest bidder. A rare piece of art is auctioned off to the highest bidder, potentially fetching a much higher price than its estimated value.
Demand-Oriented Pricing: Prices are set based on the level of demand for the product. Higher prices may be charged where demand is high and vice versa. A concert venue charges higher ticket prices for a popular artist than for a lesser-known artist, reflecting the higher demand for the popular artist.
Bargaining: Prices are negotiated between the customer and seller until a final agreement is reached.
Government Pricing Policy: Government dictates prices, especially for essential products. The government sets a price ceiling on essential goods like salt to ensure affordability for consumers.
Cost-Oriented Method: Prices are determined by the production costs incurred by the entrepreneur. A bakery calculates the cost of ingredients, labor, and overhead expenses to determine the price of its bread.
Fashion-Oriented Pricing: Prices are based on prevailing fashion trends. Higher prices for attractive fashion, lower for less trendy. A clothing retailer charges a higher price for a trendy designer dress than for a more basic dress.
Competition-Oriented Pricing: Prices are influenced by competitors for the same products. A grocery store matches the price of milk offered by its competitor across the street to remain competitive.
Limit Pricing: Existing firms collectively charge lower prices to discourage new entrants. A dominant boda company sets low prices to discourage new competitors from entering the market.
Forces of Demand and Supply: Prices are set based on customer demand and product supply in the market. The price of tomatoes increases during the planting months when supply is low and demand remains high.

Objectives for Pricing the Products:

Target the return on investment.
Target the market share.
Discourage new entrants.
Maximize short-run profits.
Determine the distribution of goods and services.
Stimulate business growth.
Establish market presence.
Maintain price leadership arrangement.

Factors Affecting Price Decisions of a Product / Factors Considered When Determining Price of a Product:

Nature of Customers: Prices vary based on customers’ income levels.
Government Policy: Government regulations may influence price decisions.
Cost of Production: High production costs lead to higher prices.
Level of Competition: High competition results in fair prices.
Main Objective of the Enterprise: Profit-maximizing enterprises charge higher prices.
Quality of Products: Higher quality products command higher prices.
Level of Demand: Higher demand justifies higher prices.
Seasonal Factor: Prices may fluctuate seasonally for certain products like school materials.

Place:

The place component focuses on where and how the product or service is purchased by customers. It includes distribution channels, physical locations, and online platforms.
Questions to consider: Which places or venues do buyers frequent for similar products? Where is the competition selling its products? What are the shopping habits of the target audience?.

Place

Place refers to the channels of distribution used to deliver products from manufacturers to consumers. Channel members, including manufacturers, wholesalers, retailers, and consumers, participate in the distribution process.

Types of Marketing Intermediaries:

Middlemen: Independent businesses acting as intermediaries between producers and consumers.
Agent: Wholesalers or retailers who facilitate buying and selling without owning the goods.
Wholesaler: Merchants engaged in bulk buying, storing, and selling goods to retailers.
Retailer: Merchants buying from wholesalers and selling to final consumers.
Broker: Facilitators arranging deals between buyers and sellers.

Channels of Distribution:

Businesses decide where and how to sell their products, considering factors like cost and efficiency.

Producer to Consumer: Direct sale from manufacturers to consumers, feasible for some products like agricultural goods.
Producer to Retailer to Consumer: Manufacturer sells to retail outlets, which then sell to consumers, common for expensive or large retailers.
Producer to Wholesaler to Retailer to Consumer: Involves wholesalers breaking bulk for small retailers who can’t buy large quantities.
Producer to Agent to Wholesaler to Retailer to Consumer: Manufacturers may use agents in other countries for exporting, allowing control over sales methods.

Promotion:

The promotion component involves reaching the target audience with the right message at the right time. It includes advertising, sales promotions, and other marketing communication strategies.
Questions to consider: When is the right time to reach the target audience? Which channels or mediums will the target audience get their information from? What advertising approaches will be the most fruitful?.

Product Promotion

Product promotion involves informing, persuading, and influencing customers’ decisions to buy goods or services.

Objectives of Promotion

Increase and stabilize sales: By promoting products, entrepreneurs aim to boost sales and maintain a stable revenue stream.
Expand market share: Promotional efforts help in capturing a larger portion of the market, leading to increased market share.
Increase business profits: Ultimately, the goal of promotion is to drive profitability by generating more sales and revenue for the business.
Inform the public about available products: Promotional activities are used to raise awareness among consumers about the products or services offered by the business.
Remind consumers of product availability: Continuous promotion serves as a reminder to existing and potential customers about the availability of the entrepreneur’s products in the market.
Outcompete other firms: Effective promotion strategies can help the business stay ahead of competitors by attracting more customers and increasing market share.
Retain existing market: Promotions can also help in retaining loyal customers by offering them incentives to continue purchasing from the business.
Introduce new products or designs: When launching new products or designs, promotion plays a crucial role in creating awareness and generating interest among consumers.
Inform new customers about product availability: Promotional efforts target not only existing customers but also potential new customers who may not be aware of the entrepreneur’s products.
Promote enterprise publicity and acquire goodwill: Promotion contributes to building the brand image and reputation of the enterprise, leading to positive perceptions among consumers.
Create direct contact between businessmen and customers: Certain promotional activities, such as events or direct marketing, facilitate direct interaction between entrepreneurs and customers, fostering relationships and trust.

Methods of Sales Promotion:

Giving free samples: Distributing free samples allows customers to try out new products, leading to potential future purchases.
Offering premium or bonus products: Including extra products as a bonus or premium incentivizes customers to make a purchase.
Exchange schemes: Offering exchange schemes encourages customers to upgrade to newer products by trading in their old ones.
Price-off offers: Discounting products encourages customers to make immediate purchases by offering them savings.
Coupons: Providing coupons entitles customers to discounts on products, incentivizing them to make purchases.
Trade fairs and exhibitions: Participating in trade fairs and exhibitions provides an opportunity to showcase products to a wider audience and generate leads.
Scratch and win offers: Interactive promotions like scratch and win offers engage customers and create excitement around the brand.
Money-back guarantees: Offering money-back guarantees reassures customers about the quality of the product, leading to increased confidence and sales.
Selling goods on credit: Providing credit options makes products more accessible to customers who may not have immediate funds available.
Window displays: Attractive window displays attract the attention of passersby and entice them to enter the store and make purchases.
Cash and trade discounts: Offering cash or trade discounts incentivizes bulk purchases and prompt payments from customers.
Donations: Making donations to charitable organizations or causes enhances the reputation of the business and builds goodwill in the community.
Organizing competitions or games: Hosting competitions or games related to the products creates engagement and excitement among customers.
Employee training: Training employees to provide excellent customer service and product knowledge enhances the overall customer experience and leads to increased sales.
Maintaining communication links: Regular communication with customers, wholesalers, retailers, and other stakeholders keeps them informed about the latest products and promotions.
Offering after-sales services: Providing after-sales services such as delivery, maintenance, and repairs enhances customer satisfaction and loyalty.
Giving out free gifts: Offering free gifts with purchases incentivizes customers to buy and creates a positive shopping experience.
Intensive advertising: Promoting products through various advertising channels increases visibility and attracts customers’ attention.

Types of Marketing

Paid Advertising: This includes paying for ads to promote products or services. For example, a clothing brand may invest in TV commercials, social media ads, or Google Ads to reach potential customers.
Cause Marketing: This involves associating a company’s offerings with a social cause. For instance, a coffee chain might donate a portion of its proceeds to support education in underprivileged communities with each cup of coffee sold.
Relationship Marketing: This focuses on building strong connections with customers to foster loyalty. An example would be a local bakery that remembers customers’ days and offers or thank-you notes or birthday messages.
Undercover Marketing: Also known as stealth marketing, promotes products without advertising. An example is a popular video game character wearing branded clothing during a movie scene, stealthy exposing viewers to the brand without directly marketing it.
Word of Mouth: This relies on satisfied customers spreading positive experiences to others. For instance, if a friend recommends a restaurant based on their enjoyable dining experience, it may prompt others to visit the restaurant.
Internet Marketing: Internet marketing leverages online platforms to promote products or services. For example, an online bookstore may use social media advertising, email newsletters, and content marketing to attract book lovers to its website.
Transactional Marketing: This strategy offers incentives to encourage immediate purchases. An example is a retail store offering limited-time discounts or buy-one-get-one-free deals to entice shoppers to make on-the-spot purchases.
Diversity Marketing: This involves tailoring marketing strategies to diverse audience segments. For instance, a beauty brand may create inclusive advertising campaigns featuring models from various ethnic backgrounds or body sizes to appeal to a wider range of consumers.

MARKETING SURVEY / RESEARCH

Market research is a systematic process of collecting and analyzing information relating to markets and opinions of the public about the products of a firm to enable present and future decision making.

Market research is the process of collecting and analyzing information relating to demand for a good or service in order to identify market opportunities and problems.

Market research is an organized effort to gather information about target markets or customers.

A target market refers to a fairly similar group of customers to whom a business product or service is aimed at.

Potential customers are a group of people sharing common needs and characteristics that a business decides to serve.

Aims / Objectives Of Carrying Out Market Research Of A Product

1. Understanding Customer Preferences: This involves researching what kind of products people want, what features are important to them, what quality they expect, how much they are willing to pay, and where and when they want to buy. This helps businesses develop products and marketing strategies that meet the needs and desires of their target customers.

2. Assessing the Market: This involves analyzing the size of the market for a particular product, the level of competition, the strengths and weaknesses of competitors, and the effectiveness of current marketing and sales strategies. This helps businesses identify opportunities for growth and make informed decisions about how to compete effectively.

3. Making Informed Decisions: This involves using market research data to make decisions about product development, pricing, marketing, distribution, and other business strategies. This helps businesses make data-driven decisions that are likely to lead to success.

4. Reducing Risk: Market research helps businesses identify and mitigate potential risks associated with new products or markets. This can save businesses time, money, and resources.

5. Identifying Opportunities: Market research can help businesses identify new opportunities for product development, market expansion, and other growth opportunities. This can help businesses stay ahead of the competition and achieve their long-term goals.

6. Testing and Improving: Market research can be used to test the effectiveness of marketing campaigns or product designs. This helps businesses improve their products and marketing strategies over time.

7. Gaining a Competitive Advantage: By understanding the market and its customers better than competitors, businesses can gain a big advantage. This can lead to increased sales, market share, and profitability.

8. Boosting Sales and Distribution: This involves identifying the best ways to distribute products to reach the most consumers, and understanding how to increase sales and turnover. This helps businesses optimize their distribution and sales strategies for maximum impact.

9. Increasing Profitability: By improving product development, marketing, and distribution based on market research data, businesses can maximize their efficiency and profitability. This then leads to increased revenue.

10. Understanding Market Trends: Market research helps businesses identify emerging trends and anticipate future changes in the market. This allows them to adapt their strategies and stay relevant.

15. Building a Strong Brand: Market research helps businesses understand how consumers perceive their brand and identify opportunities to strengthen their brand image. This leads to increased brand awareness, loyalty, and big market share.

Methods / Tools Of Market Research

Observation method. This is where the entrepreneur watches the behaviour and attitudes of the public towards his product and products of competitors. It involves making an informal survey by observing business activities in the community. It reveals the need for the particular business.
Experimental method. This is where an entrepreneur sells his products within a small selected area before selling on a large scale. If the product is liked within a small selected area, then the entrepreneur can distribute nationwide.
Interviewing method. Under this method, the entrepreneur asks oral questions either face to face or by telephone to obtain response from people towards his products. It is a formal discussion which can identify the shortcomings of the business.
Telephone surveys. Under this method, an entrepreneur calls different groups of customers to obtain information about aspects of the product to establish the market stand.
Questionnaire method. Under this method, an entrepreneur carefully designs questions which are printed on paper then sent to possible respondents to give answers. It is a formal survey which obtains market information.
Personal contacts. This involves making an informal survey by talking to family members and friends. These provide information about the best business to set up and the best products to be purchased in the locality.
Surfing / use of the internet. This is where information is gathered through surfing from different websites from the internet.
SWOT analysis. This method involves collecting data by a business through gathering information about its strengths, weaknesses, as well as information about opportunities and threats from the outside environment.

Steps Taken In Carrying Out Market Research / Survey

Imagine you’re a hospital administrator looking to improve patient satisfaction and attract new patients. You decide to conduct market research to understand your target audience’s needs and preferences.

Define the Problem: You want to know what factors influence patients’ choice of hospital, what services they value most, and what areas of improvement they see.
Define the Sample: You decide to survey 200 patients who have recently been discharged from your hospital, as well as 100 patients who have chosen to receive care at a competitor’s hospital.
Collect Data: You create a survey with questions about patient satisfaction with various areas of care, including wait times, communication with staff, cleanliness, and hospital experience. You also ask about patients’ reasons for choosing your hospital or a competitor’s.
Analyze the Results: You analyze the survey data to identify trends and patterns. For example, you might find that patients value attention, clear communication from doctors and nurses, and a comfortable environment. You might also discover that some patients choose competitors due to shorter wait times or more specialized services.
Make the Research Report: You create a report summarizing the findings of your survey. You clearly present the data. For example, you might recommend investing in additional staff to reduce wait times, improving communication, and trying new service offerings to better meet patient needs.
Make Decisions: Based on your research, you decide to implement several initiatives to improve patient satisfaction. You hire additional nurses to reduce wait times, conduct training for staff on effective communication, and invest in new equipment to offer more specialized services. By understanding patients’ needs and preferences, you can make informed decisions that will improve their experience and attract new patients to your hospital.

Sources Of Data For Conducting Market Research

Competitors / competition. This is where data is collected by monitoring the activities of competitors in the same line of business. This may provide important information about customers’ demands that were overlooked and they may be capturing part of the market by offering something unique.
Customers. The entrepreneur should talk to customers to get their feelings and ask them where improvement can be made. Encouraging and collecting customers’ comments is an effective form of research which involves asking customers to explain how the product could be improved to satisfy their needs.
Employees (workers). This is one of the best sources of information about customers’ feelings, likes and dislikes, usually employees work more directly with the customers and hear their complaints that may not reach the owner. They are in most cases aware of the items customers request for that the business does not offer.
Company records and files. Examining company records and files can be very informative e.g looking at the sales records, complaints, receipts or any other records can show an entrepreneur where his customers live and work, what their preference is, amount purchased etc. Using suggestion boxes can also be a source of information.

Problems Faced When Conducting Market Research Of A Given Product

Language difference. Given that Uganda lacks a national language, researchers sometimes miss the information they desire to get due to inability to communicate in the languages understood by the different respondents / consumers.
Inadequate financial resources. It is very expensive to carry out market research. Small firms with limited capital may not be able to undertake it and this greatly affects their planning.
Inadequate skills to handle data collection due to limited man power to effectively and efficiently handle market research. This leads to inaccurate interpretation of information from the public.
Inadequate communication facilities. Accessibility of some areas of the country is difficult due to poor road networks. Therefore, information from such areas cannot easily be obtained by researchers.
Inadequate co-operation from the customers or public. Some people refuse to answer the questions; others give wrong answers while some chase away the researchers. All these distort research findings and conclusions.
Insecurity / hostility in some areas which hinder effective data collection.
Bias. There is also a possibility of getting information from a biased sample / source.
Wrong target group. Choice of wrong sample target group of customers or people from where to get information.
Inaccurate data. Most people or customers do not keep records of their sales or purchases and therefore not being able to get accurate information from them.
Political instabilities also affect research as the researchers may not be able to go to the areas of their choice.

MARKETING Read More »

FRANCHISING

WAYS OF EXPANDING A BUSINESS:

Franchising: Franchising involves granting another party the right to operate a business under your brand and using your established business model.
Joint Ventures: A joint venture involves partnering with another company to create a new business entity.
Distributorship: Distributorship involves partnering with another company to distribute your products or services to a wider market.
Organic growth: Growing your business through internal means, such as increasing sales, expanding your product or service offerings, or entering new markets.

FRANCHISING

Franchising involves granting another party the right to operate a business under your brand and using your established business model.

A franchise is the agreement or license between two legally independent parties which gives:

A person or group of people (franchisee) the right to market a product or service using the trademark or trade name of another business (franchisor).
The franchisee the right to market a product or service using the operating methods of the franchisor.
The franchisee the obligation to pay the franchisor fees for these rights.
The franchisor the obligation to provide rights and support to franchisee.

FRANCHISOR

Owns trademark or trade name
Provides support (sometimes) financing with franchisor’s support, advertising & marketing, training
Receives fees

FRANCHISEE

Uses trademark or trade name
Expands business
Pays the fees

TYPES OF FRANCHISES

There are two main types of franchises:

Product distribution.
Business format.

Product distribution franchises simply sell the franchisor’s products and are supplier-dealer relationships. In product distribution franchising, the franchisor licenses its trademark and logo to the franchisee but does not provide them with an entire system for running their business.

Business format franchises, on the other hand, not only use a franchisor’s product, service, and trademark but also the complete method to conduct the business itself, such as the marketing plan and operations manuals. Business format franchises are the most common type of franchise.

TYPES OF FRANCHISE ARRANGEMENTS/AGREEMENTS

These arrangements define the relationship between the franchisor (the owner of the business concept) and the franchisee (the individual or entity purchasing the rights to operate a franchise).

Two types of franchising arrangements:

Single-unit (direct-unit) franchise
Multi-unit franchise

Single-unit (direct-unit) franchise is an agreement where the franchisor grants a franchisee the rights to open and operate ONE franchise unit. This is the simplest and most common type of franchise.

Multi-unit franchise is an agreement where the franchisor grants a franchisee the rights to open and operate MORE THAN ONE unit.

There are two ways a multi-unit franchise can be achieved:

An area development franchise
A master franchise

Under an area development franchise, a franchisee has the right to open more than one unit during a specific time, within a specified area. For example, a franchisee may agree to open 5 units over a five-year period in a specified territory.

A master franchise also known as sub-franchising, a master franchise agreement grants the franchisee the rights to develop and sell franchises within a specific territory. The master franchisee assumes many of the responsibilities of the franchisor, such as training and support, and receives a portion of the franchise fees and royalties from the sub-franchisees they recruit.

In addition to having the right and obligation to open and operate a certain number of units in a defined area, the master franchisee also has the right to sell franchises to other people within the territory, known as sub-franchises. Therefore, the master franchisee takes over many of the tasks, duties, and benefits of the franchisor, such as providing support and training, as well as receiving fees and royalties.

A damaged, system-wide image can result if other franchisees are performing poorly or the franchisor runs into an unforeseen problem. The term (duration) of a franchise agreement is usually limited, and the franchisee may have little or no say about the terms of a termination.

LEGAL ISSUES OF FRANCHISING

A good relationship between the franchisor and franchisee is critical for the success of both parties.

Since franchising establishes a business relationship for years, the foundation must be carefully built by having a clear understanding of the franchise program. Franchising is governed by federal and state laws that require franchisors to provide prospective franchisees with information that describes the franchisor-franchisee relationship.

The two main franchising legal documents are the:

Franchise Disclosure Document (FDD)/Uniform Franchise Offering Circular (UFOC).
Franchise agreement

Franchise Disclosure Document (FDD)/Uniform Franchise Offering Circular (UFOC).

The Uniform Franchise Offering Circular (UFOC), now known as the Franchise Disclosure Document (FDD), is a document required by the Federal Trade Commission (FTC) for franchisors to provide to potential franchisees. It contains important information about the franchise opportunity and helps potential franchisees make informed decisions before investing in a franchise.

Key information disclosed in the UFOC/FDD includes:

Business Description: The document provides a description of the franchise business, including its history, founders, and incorporation dates.
Franchise Fees and Royalties: The UFOC/FDD discloses the upfront franchise fee, ongoing royalties, and any additional advertising royalties.
Officers and Executives: The document includes a summary of the officers, directors, and other executives involved in the franchise.
Litigation History: The UFOC/FDD provides information about any major civil, criminal, or bankruptcy actions involving the officers, executives, or the franchise company itself.
Franchise Agreement Terms: One of the most important parts of the UFOC/FDD is the section that outlines the terms of the franchise agreement. This includes the initial term, renewal options, and any conditions for termination.
Initial Costs and Financial Projections: The UFOC/FDD approximates the initial costs of starting the franchise, including equipment, inventory, operating capital, and insurance.
Termination and Territory: The document lists the reasons a franchisor may terminate the franchise before the contract expires.
Franchisor’s Responsibilities: The UFOC/FDD describes the franchisor’s obligations to the franchisee, including training, location selection, assistance with advertising, and ongoing support.

Franchise Agreement:

The Franchise Agreement is a legally binding contract between the franchisor and franchisee that governs their relationship.

It outlines the rights and obligations of both parties, including the use of trademarks, territory rights, compliance with standards, ongoing fees, and support provided by the franchisor.
The Franchise Agreement ensures that all franchisees within the organization are treated equally.
It is important to have a well-drafted Franchise Agreement that clearly defines the expectations and responsibilities of both parties.

ALTERNATIVES TO FRANCHISING

In addition to franchising, there are two other popular methods by which businesses expand their market and distribution channels:

Distributorships
Licensing

DISTRIBUTORSHIPS

In a distributorship, the distributor usually:

Has a contractual relationship with the supplier.
Buys from the supplier in bulk and sells in smaller quantities.
Is familiar with local markets and customers.
May do business with many companies, more than just the supplier/producer.
May not receive contractual support and training from the supplier/producer like a franchisee.

Some distribution arrangements are similar to franchises, and vice versa. A franchisee with a great deal of leeway in how to run the business may look like an independent distributor. A distributor may be subject to many controls by the supplier/producer and begin to resemble a franchise.

LICENSING

Licensing, on the other hand, allows a licensee to pay for the rights to use a particular trademark. Unlike franchises, in which the franchisor exerts significant control over the franchisee’s operations, licensors are mainly interested in collecting royalties and supervising the use of the license rather than influencing the operations of the business.

FRANCHISING Read More »

BUSINESS START-UPS

Startup refers to a company in the first stages of operations. Startups are founded by one or more entrepreneurs who want to develop a product or service for which they believe there is demand.

These companies usually start with high costs and limited revenue, which is why they look for capital from a variety of sources such as venture capitalists, crowdfunding, and loans.

Advantages and Disadvantages of Startups

Advantages	Disadvantages
More opportunities to learn	Risk of failure
Increased responsibility	Having to raise capital
Flexibility	High stress
Workplace benefits	Competitive business environment
Innovation is encouraged	Long hours
Flexible hours

WHAT ARE YOUR OPTIONS WHEN YOU BEGIN YOUR BUSINESS?

The entrepreneur here looks at options of how to start a business. There are several ways on how a business can be started as discussed below.

Starting from scratch; This calls for starting a business from nowhere to somewhere. This involves starting a business from the ground up. This requires collecting all the factors of production and put them together to have a business started. Most entrepreneurs go this way to start small businesses and they grow them into large businesses.
Inheriting an existing business; Some entrepreneurs inherit businesses from their parents or other relatives. This can be a great way to get started in business, as the entrepreneur may already have a customer base and a team of employees in place. For instance the current owner of Madhivan group is a grandson of the first Madhivan who started the business. He inherited business from his father.
Buying an existing business; Entrepreneurs can also purchase existing businesses from other owners. For instance someone may be selling out a failed business or with other prospects of changing line of business and someone with money goes ahead and buys the business facility and start his entrepreneurial career from their onwards
Franchise; A franchise is a business that is operated under the name and trademarks of another company. The franchisee pays a fee to the franchisor for the right to use the franchisor’s brand, products, and services. This requires the entrepreneur to start a business in the same line with that of the parent company. He may have to get rights from the owner and he runs the business elsewhere. For example the Baroda Bank of Uganda is a franchise of Baroda bank of India
Business Incubation. This is where existing entrepreneurs, organizations or government agencies provide facilities to help new entrepreneurs get started, trained and provided with operating tools, facilities and land or space. Organizations like Uganda Industrial Research Institute (UIRI), FINAfrica at UMA Logogo, and Global Labs Uganda.

Features of a Business:

Exchange of Goods and Services: All business activities involve the exchange of goods or services for money or its equivalent. This exchange is the core of business transactions.
Deals in Numerous Transactions: Businesses regularly engage in multiple transactions, not just one or two. This ongoing exchange of goods and services is a defining characteristic of business activity.
Profit is the Main Objective: Businesses are driven by the profit motive, aiming to generate revenue that exceeds expenses. Profit is the reward for the services provided by the business owner or entrepreneur.
Business Skills for Economic Success: Running a successful business requires specific skills and qualities. A good businessman or entrepreneur needs experience, knowledge, and the ability to make sound decisions in a dynamic and often uncertain business environment.
Risks and Uncertainties: Business activities are subject to various risks and uncertainties. Some risks, such as loss due to fire or theft, can be managed through insurance. However, other uncertainties, such as changes in demand or price fluctuations, cannot be insured and must be borne by the business owner.
Buyer and Seller: Every business transaction involves at least two parties: a buyer and a seller. Business is essentially a contract or agreement between these parties, where goods or services are exchanged for money or other forms of compensation.
Connected with Production: Business activities can be related to the production of goods or services. When a business is involved in the production of goods, it is referred to as an industrial activity. Industries can be classified as primary (extracting raw materials) or secondary (transforming raw materials into finished goods).
Marketing and Distribution of Goods: Business activities can also involve the marketing or distribution of goods. This is known as commercial activity. Businesses engaged in marketing and distribution focus on connecting producers with consumers, ensuring that goods reach their intended markets.
Deals in Goods and Services: Businesses deal in both goods (tangible products) and services (intangible offerings). Consumer goods are those used directly by consumers, while producer goods are used in the production of other goods. Services are intangible but can be exchanged for value, such as transportation, warehousing, and insurance services.
To Satisfy Human Wants: Businesses aim to satisfy human wants and needs through their products and services. By producing and supplying various commodities, businesses contribute to consumer satisfaction and well-being.
Social Obligations: Modern businesses recognize their social responsibility and strive to operate in a manner that benefits society as a whole. This includes ethical business practices, environmental sustainability, and contributing to the community.

Basics of a Business:

Business Concept: Every business starts with an idea or concept that addresses a market need or opportunity.
Market Research: Depending on the business type, extensive market research may be necessary to evaluate the viability of the concept and identify target customers.
Business Name: Selecting a suitable business name is essential, considering factors such as memorability, relevance to the business, and legal availability.
Legal Structure: Businesses can choose from various legal structures, such as sole proprietorship, partnership, corporation, or limited liability company (LLC), each with its own advantages and disadvantages.
Financing: Starting and operating a business requires financing, which can come from personal savings, loans, or investors.
Operations: Businesses must establish efficient systems and processes for production, distribution, marketing, and customer service.
Marketing: Businesses need to develop and implement marketing strategies to promote their products or services and attract customers.
Customer Service: Providing excellent customer service is crucial for building customer loyalty and maintaining a positive reputation.
Financial Management: Businesses must manage their finances effectively, including revenue, expenses, profits, and cash flow.
Compliance: Businesses are required to comply with various laws and regulations, such as tax laws, employment laws, and industry-specific regulations.

BUYING A NEW BUSINESS

When it comes to business ownership, some entrepreneurs choose to bypass the process of starting from scratch or acquiring a franchise by opting to buy an existing business.

The route to acquiring a business demands thorough due diligence, a process as demanding as creating a business plan for a new venture. This due diligence is important as it uncovers both the strengths and weaknesses of a business; skipping it can lead to unforeseen problems that may doom the business to failure.

Advantages of Buying an Existing Business:

Proven Success: A thriving business with a solid track record offers a higher chance of continued success. It comes with an established customer base, supplier relationships, and operational systems.
Prime Location: Buying a business ensures you start at the right location, avoiding the risk of second-choice locations that might not attract the same customer traffic.
Experienced Workforce: Existing businesses come with knowledgeable employees who can guide through the transition and contribute to continuous revenue generation.
Operational Equipment: The necessary equipment is already in place, and its capacity and condition can be assessed prior to purchase, saving on initial investment costs.
Inventory and Trade Credit: Successful businesses have already figured out the right balance of inventory and have established trade credit relationships, which new owners can benefit from.
Immediate Operation: Buying an existing business allows owners to start earning immediately without the delays of setting up a new venture.
Leveraging Past Owner’s Experience: Even if the previous owner is not present, their records and decisions provide valuable insights for the new owner.
Easier Financing: It’s often simpler to secure financing for an existing business, especially one with a good relationship with lenders.
Potential Bargains: Sometimes businesses are sold at a low price due to various reasons, offering a good deal for the discerning buyer.

Disadvantages of Buying an Existing Business:

Risk of a Failing Business: Some businesses are on sale because they’re struggling.
Unsuitable Employees: Inherited staff may not align with the new owner’s vision, necessitating difficult decisions.
Deteriorating Location: Changes in demographics or competition could render a previously ideal location unsuitable.
Outdated Equipment: Unforeseen costs can arise if the existing equipment or facilities are found to be outdated or inefficient after purchase.
Resistance to Change: Implementing new policies or innovations can be challenging due to established practices and customer expectations.
Tangible limitations:

Design problems: The business’s physical layout, branding, or website may be outdated and require costly renovations or updates.
Location problems: The business may be located in an inconvenient location, making it difficult for customers to access.
Merchandise problems: The business may have outdated inventory, that is no longer in demand, limited product selection, or may sell products of poor quality, leading to customer dissatisfaction.

Intangible limitations:

Customer or employee ill will: The business may have a negative reputation among customers or employees, making it difficult to attract new business or retain staff, Key employees may leave too.
Pricing problems: The business may be overpriced, making it difficult to recoup the investment.

Potentially higher costs to buy: There may be hidden costs associated with the business, such as environmental liabilities or outstanding debts.
Legal liability in inheriting lawsuits: The business may be facing existing lawsuits that the buyer will inherit.

STEPS IN ACQUIRING/BUYING AN EXISTING BUSINESS

Buying an existing business can be risky if approached without following the steps.

1. Self-Assessment: Identifying the Right Business

Begin with introspection. Assess your skills, preferences, and aspirations to pinpoint the type of business that aligns with your strengths and interests. Questions to consider include:

What business activities captivate or repel you?
Which industries hold the promise of growth and pique your interest?
What are your expectations from owning a business?
Evaluate your readiness in terms of time, energy, financial investment, and risk tolerance.
This self-audit lays the groundwork for identifying businesses that not only match your criteria but also promise fulfillment and success.

2. Prepare a list of potential candidates.

Once you know what your goals are for acquiring a business, you can begin your search. Do not limit yourself to only those businesses that are advertised as being “for sale.” The hidden market of companies that might be for sale but are not advertised as such is one of the richest sources of top-quality businesses. Many businesses that can be purchased are not publicly advertised but are available either through the owners or through business brokers and other professionals. Although they maintain a low profile, these hidden businesses represent some of the most attractive purchase targets a prospective buyer may find.

3. Investigate and Evaluate Candidate Businesses and Evaluate the Best One

Patience is key in this phase. Thoroughly investigate each candidate by examining their financial health, market position, competitive landscape, and operational strengths and weaknesses. This helps in shortlisting the most promising businesses. This process also will make the task of valuing the business much easier.

4. Explore Financing Options

The next challenging task in closing a successful deal is financing the purchase. Although financing the purchase of an existing business usually is easier than financing a new one, some traditional lenders shy away from deals involving the purchase of an existing business. Those that are willing to finance business purchases normally lend only a portion of the value of the assets, and buyers often find themselves searching for alternative sources of funds. Fortunately, most business buyers have access to a ready source of financing: the seller, Seller financing often is more flexible, faster, and easier to obtain than loans from traditional lenders.

5. Ensure a Smooth Transition

Once the parties strike a deal, the challenge of making a smooth transition immediately arises. No matter how well planned the sale is, there are always surprises. For instance, the new owner may have ideas for changing the business that cause a great deal of stress and anxiety among employees and the previous owner.

To avoid a bumpy transition, a business buyer should do the following:

Concentrate on communicating with employees. Business sales are fraught with uncertainty and anxiety, and employees need reassurance.
Be honest with employees. Avoid telling them only what they want to hear. Share with the employees your vision for the business in the hope of generating a heightened level of motivation and support.
Listen to employees. They have first-hand knowledge of the business and its strengths and weaknesses and usually can offer valuable suggestions for improving it.
Consider asking the seller to serve as a consultant until the transition is complete. The previous owner can be a valuable resource, especially to an inexperienced buyer.

Evaluating an Existing Business

Buying an existing business can be a great opportunity, giving you an established brand, customers, and immediate income. But finding the right business to buy isn’t easy—it’s a time-consuming, costly, and sometimes frustrating process.

Evaluating a business means assessing and analyzing various areas of a business to determine its value, potential risks, and viability. It involves thoroughly examining factors such as financial performance, market position, operations, assets, liabilities, reputation, and legal compliance.

The purpose of evaluating a business is to gain a clear understanding of its strengths, weaknesses, opportunities, and threats before making a decision to buy or invest in it.

Ways of evaluating an existing business before purchase include;

1. Personal Assessment and Criteria: First, consider if the business aligns with your interests, resources, and skills. Evaluate if it’s the right fit for you in terms of cash, credibility, skills, and contacts.

2. Perform due diligence: This involves researching and confirming the details of the business to ensure you are buying what you expect and to assess its value. Create a team of experts including a banker, industry-specific accountant, attorney, and possibly a small business consultant to perform due diligence. During due diligence, focus on five critical areas:

Owner’s Reason for Selling: Understand the true motive behind the sale.
Physical Condition: Assess the state of physical assets like equipment and inventory.
Market Potential: Find out market demand, customer base, and competition to gauge growth opportunities and risks.
Legal Aspects: Thoroughly vet legal considerations such as collateral, contract assignments, and ongoing liabilities.
Financial Health: Analyze financial records with an accountant’s help to assess profitability, stability, and develop future projections.

3. Ask for the Business Plan: Does the seller have a business plan? This document (or lack thereof) can reveal a lot about the business’s history, future plans, and the owner’s commitment to selling.

4. Assess the Seller: Your relationship with the seller is important, as you’ll depend on them for information. Pay attention to your interactions during the initial investigation—signs of difficulty now could mean trouble later.

5. Get a picture of operations: Understand how the business operates by assessing its working capital, manufacturing and operations processes, supply chain, and capital expenditures. Ensure that the business is running smoothly and efficiently.

6. Evaluate the assets involved: Determine what assets are included in the transaction and their value. This includes intellectual property, brand names, trademarks, patents, and other important assets. Assess how these assets are protected and their significance to the business.

7. Consider the firm’s reputation: Research the company’s reputation by checking review sites, media outlets, and any past incidents that may have affected its reputation. A strong reputation can positively impact the business’s value.

8. Verify business licenses and permits: Ensure that the business has all the necessary licenses and permits to operate legally. Check if the required permissions are up-to-date to avoid any potential interruptions or fines after the acquisition.

9. Confirm the business’ entity status: If the business is a partnership, corporation or limited liability company (LLC) or joint stock company, review entity documents and related records to ensure the business is registered and in good standing. Verify that the owner has the legal rights to sell the business.

Protecting Your Idea

1. Intellectual Property: Business ideas, inventions, logos, and unique product names can be considered intellectual property if recorded in written, audio, or video format.

2. Legal Forms of Protection:

Patents: Exclusive rights granted for a fixed period to inventors of new and useful products or processes.
Trademarks: Names or symbols used in trade that are subject to government regulation.
Copyright: Exclusive rights regulating the use of original creations, including text, video, audio, and multimedia formats.

3. Importance of Secrecy: Be cautious about disclosing your idea to others, especially those you don’t trust.

4. Written Documentation: Place your idea in writing, including a detailed description and sketches if applicable.

5. Registering Patents and Trademarks:

Patents: File a patent application with the appropriate government agency.
Trademarks: Register your trademark in the relevant country or region.

6. Applying Copyright: Copyright protection is automatic in most countries and does not require registration. However, adding the copyright symbol (©) to your work is recommended.

7. Notarization: Consider having your written description of your idea notarized for added legal protection. Notarization is the official act of verifying the authenticity of a signature on a document and confirming the identity of the signer.

Protecting a business

Protecting a business involves safeguarding its assets, reputation, and future viability from various threats.

This includes ways encompassing legal, financial, operational, and strategic measures.

Ways of Protecting a business

1. Legal Protection:

Intellectual Property Protection: Registering trademarks, patents, copyrights, and trade secrets to protect your unique creations and brand identity. This prevents unauthorized use and provides legal recourse against infringement.
Contractual Agreements: Developing and enforcing robust contracts with suppliers, customers, and employees to clearly define responsibilities, obligations, and liabilities. This minimizes disputes and protects against breaches.
Business Structure: Choosing the right legal structure (sole proprietorship, partnership, LLC, corporation) impacts liability and tax obligations. Consult with legal professionals to determine the best structure for your specific business and risk tolerance.
Insurance: Obtaining comprehensive insurance coverage, including general liability, professional liability (errors and omissions), property insurance, and business interruption insurance, safeguards against financial losses from unforeseen events.
Compliance: Adhering to all relevant laws and regulations (environmental, labor, consumer protection, etc.) minimizes legal risks and prevents penalties.

2. Financial Protection:

Diversification: Don’t rely on a single revenue stream or customer. Diversify products/services and customer base to mitigate the impact of market fluctuations or loss of a major client.
Financial Planning & Budgeting: Developing detailed financial plans and budgets helps track expenses, manage cash flow, and identify potential financial vulnerabilities.
Credit Management: Implementing effective credit policies and procedures minimizes bad debts and ensures timely payment from customers.
Fraud Prevention: Establishing robust internal controls and procedures to prevent fraud, embezzlement, and other financial misconduct. Regular audits can also help.
Emergency Funds: Maintaining sufficient reserves to handle unexpected expenses or economic downturns ensures business continuity during challenging times.

3. Operational Protection:

Data Security: Protecting sensitive business data (customer information, financial records, intellectual property) from cyberattacks, data breaches, and unauthorized access through strong cybersecurity measures.
Risk Management: Identifying, assessing, and mitigating potential risks to the business (operational disruptions, supply chain issues, natural disasters, etc.) through proactive planning and contingency measures.
Physical Security: Protecting physical assets (equipment, inventory, premises) from theft, vandalism, and damage through security systems, access controls, and insurance.
Disaster Recovery Planning: Developing a comprehensive plan to recover from disruptions caused by natural disasters or other unforeseen events.
Redundancy & Backup: Implementing backup systems and procedures for critical systems and data to ensure business continuity in case of failure.

4. Strategic Protection:

Brand Management: Building a strong brand reputation through consistent quality, excellent customer service, and ethical business practices protects against negative publicity and reputational damage.
Competitive Advantage: Developing and maintaining a competitive advantage through innovation, efficiency, and superior customer service protects against market competition.
Strategic Partnerships: Collaborating with strategic partners can provide access to resources, expertise, and markets, enhancing the business’s resilience and competitiveness.
Market Research & Analysis: Continuously monitoring market trends, competitor activities, and customer preferences helps identify potential threats and opportunities.
Adaptability: Being adaptable and responsive to changes in the market and business environment is crucial for long-term survival.

FRANCHISING

Click here

BUSINESS START-UPS Read More »

OPPORTUNISTIC INFECTIONS IN HIV/AIDS

Opportunistic infections (OIs) are infections affecting HIV patients with weakened immunity, indicated by a white blood cell count below 200 cells/cm³ (14%).

Advanced HIV infection makes individuals vulnerable to opportunistic infections or malignancies. These infections exploit the weakened immune system.
Childhood acquisition of OIs and HIV often occurs from infected mothers.
Women living with HIV are more prone to co-infections with opportunistic pathogens, increasing the risk of transmission to their infants.
Adolescents with HIV, including long-time survivors of perinatal infection, are increasingly common. Treatment guidelines also apply to youth living with HIV who have not yet completed pubertal development.

Examples of Opportunistic Infections

Category	Infection	Explanation
Bacterial OIs	Pneumococcal pneumonia	A bacterial infection causing severe respiratory illness, commonly affecting HIV patients due to weakened immunity.
	Pulmonary tuberculosis	A serious infectious disease that primarily affects the lungs, prevalent in HIV patients due to compromised immune defenses.
	Salmonellosis	An infection caused by Salmonella bacteria, leading to severe gastrointestinal symptoms, more common in immunocompromised individuals.
	Extra-pulmonary tuberculosis	Tuberculosis infection occurring outside the lungs, such as in the lymph nodes or bones, often seen in advanced HIV cases.
Viral OIs	Herpes zoster	Also known as shingles, caused by the reactivation of the chickenpox virus, leading to painful skin rashes in HIV patients.
Viral OIs	Recurrent/disseminated viral herpes simplex	Chronic or widespread herpes simplex virus infections, more severe and frequent in individuals with HIV.
Parasitic OIs	Pneumocystis carinii pneumonia	A fungal infection (previously classified as parasitic) causing severe lung disease, a common and life-threatening infection in HIV patients.
Parasitic OIs	Toxoplasmosis	An infection caused by the Toxoplasma gondii parasite, leading to severe neurological issues in immunocompromised individuals like those with HIV.
Fungal OIs	Cryptosporidium	A parasitic infection causing severe diarrhea, often found in HIV patients due to their weakened immune systems.
	Oro-pharyngeal candida	A fungal infection in the mouth and throat, also known as thrush, common in HIV patients.
	Candida Esophagitis	A severe fungal infection of the esophagus, causing difficulty in swallowing and chest pain, prevalent in advanced HIV cases.
	Histoplasmosis	A fungal infection caused by inhaling Histoplasma spores, leading to lung disease, more severe in immunocompromised patients.
	Coccidioidomycosis	A fungal disease also known as Valley fever, causing respiratory issues, especially severe in those with weakened immune systems.
	Cryptococcal meningitis	A life-threatening fungal infection of the brain and spinal cord, common in advanced HIV/AIDS patients.
Opportunistic Cancers	Invasive cervical cancer	Cancer caused by the human papillomavirus (HPV), more prevalent and aggressive in women with HIV.
	Kaposi sarcoma	A cancer caused by human herpesvirus 8 (HHV-8), leading to lesions on the skin and other organs, commonly seen in HIV patients.
	Non-Hodgkin lymphoma	A type of cancer affecting the lymphatic system, more common and aggressive in individuals with HIV.
Other OIs	Oral hairy leukoplakia	A condition characterized by white patches on the tongue, caused by Epstein-Barr virus, indicating immunosuppression in HIV patients.
	Leukoencephalopathy	A rare, progressive viral disease affecting the white matter of the brain, often seen in severe immunocompromised states like advanced HIV.
	Progressive multifocal leukoencephalopathy	A demyelinating disease of the central nervous system caused by the JC virus, highly fatal in HIV patients.

Causes of Opportunistic Infections:

Poor adherence to treatment
Presence of other diseases (e.g., juvenile diabetes mellitus)
Delay in identification of the infection
High viral load
Poor nutrition
Exposure to opportunistic infectious agents
Ingestion of substances contaminated with opportunistic infectious agents
Missing out on immunization programs
Poor hygiene
Poor sanitation
Poor ventilation

Prevention of Opportunistic Infections:

Avoidance of contact with the disease agents
Proper treatment of other underlying diseases
Adherence to HIV drug treatment
Immunization of children against killer diseases
Ensuring that children consume well-cooked food and boiled water
Early identification and treatment of opportunistic diseases
Health education of the family and infected child about opportunistic infections

HEPATITIS B

Hepatitis B is a chronic liver infection characterized by inflammation of hepatocytes caused by the hepatitis B virus.

Transmission:

High: Blood
Moderate: Semen, Urine, Serum, Wound exudate, Vaginal fluid
Low/Not Detectable: Saliva, Feces, Sweat, Tears, Breast milk

Stages of Hepatitis B:

Immune Tolerance: Represents the incubation period, lasting approximately 2-4 weeks in healthy adults, and often decades in newborns.
Immune Active/Immune Clearance: Inflammatory reaction occurs with active viral replication. Duration varies; for acute infection, approximately 3-4 weeks; for chronic infection, up to 10 years.
Inactive Chronic Infection: Host targets infected hepatocytes and HBV, with low or no measurable viral replication in serum. Anti-HBe can be detected.
Chronic Disease: Chronic HBeAg-negative disease may emerge.
Recovery: Virus undetectable in blood, antibodies to viral antigens produced.

Clinical Features:

Symptoms can be symptomatic or asymptomatic:

Weakness, malaise, low-grade fever
Nausea, loss of appetite, vomiting
Pain or tenderness over right upper abdomen
Jaundice, dark urine, severe pruritus
Enlarged liver
Complications: liver cirrhosis, hepatocarcinoma

Investigations:

Hepatitis B surface antigen positive for >6 months
Hepatitis B core antibody: Negative IgM and Positive IgG to exclude acute hepatitis B infection
Liver tests, repeated at 6 months
HBeAg (can be positive or negative)
HBV DNA if available
HIV serology
APRI (AST to Platelets Ratio Index): a marker for fibrosis
Alpha fetoprotein at 6 months
Abdominal ultrasound at 4-6 months

Management:

General Principles:

Screen for HIV and refer if positive.
Refer to a regional hospital for specialist management if HIV is negative.
Antiviral treatment is given to prevent complications and usually for life.
Patients with chronic hepatitis B need periodic monitoring and follow-up for life.
Periodic screening for hepatocarcinoma with alfa fetoprotein and abdominal ultrasound once a year.

Treatment with Antivirals:

Treat with antivirals based on specific criteria.

First-line antivirals:

Adults and children >12 years or >35 kg: tenofovir 300 mg once a day
Child 2-11 years (>10 kg): Entecavir 0.02 mg/kg

Health Education:

Management is lifelong.
Bed rest is recommended.
Avoid alcohol as it worsens the disease.
Immunization of household contacts.
Do not share items that the patient puts in the mouth (e.g. toothbrushes, cutlery, razor blades).

OPPORTUNISTIC INFECTIONS IN HIV/AIDS Read More »

Post-exposure prophylaxis (PEP)

Post-exposure prophylaxis (PEP) involves the short-term use of antiretroviral medications to reduce the risk of acquiring HIV infection after potential exposure, either occupational or non-occupational.

Types of Exposure:

Occupational Exposures: Occur in healthcare or laboratory settings, including needle stick injuries or body fluid splashes.
Non-occupational Exposures: Include unprotected sex, assault (e.g., rape), and accidents.

Steps for Providing PEP:

Step 1: Clinical Assessment and First Aid

Rapidly assess the client to evaluate exposure and risk, providing immediate care.
For needle stick injuries: Avoid squeezing, wash the site with mild disinfectant, and do not use strong antiseptics.
For body fluid splashes on intact skin: Wash the area immediately with mild disinfectant.

Step 2: Eligibility Assessment

Provide PEP if exposure occurred within 72 hours and the exposed individual is HIV-negative.
PEP is not provided if the individual is already HIV-positive, the source is known to be HIV-negative, or if exposure involves bodily fluids posing minimal risk.

Step 3: Counselling and Support

Provide comprehensive counseling on HIV risk, PEP benefits and side effects, adherence, and support for further assistance, especially in cases of sexual assault.

Step 4: Prescription

PEP should be started as early as possible, not beyond 72 hours of exposure.
Recommended regimens include:
For pregnant mothers/adults: TDF+3TC+ATV/r.
For children: ABC+3TC+LPV/r.
A complete course of PEP should run for 28 days.
Do not delay the first doses because of a lack of baseline HIV test.
Document the event and patient management in the PEP register (ensure confidentiality of patient data).

Step 5: Provide follow-up

Discontinue PEP after 28 days.
Perform follow-up HIV testing three months after exposure.
Counsel and link to HIV clinic for care and treatment if HIV-positive.
Provide prevention and education/risk reduction counselling if HIV-negative.

ORAL PRE-EXPOSURE PROPHYLAXIS (PrEP)

PrEP involves using ARV drugs by individuals not infected with HIV to prevent HIV acquisition.

Where will PrEP services be offered?

Initially, PrEP will be available in select accredited ART sites with the capacity and funding for comprehensive services. Further rollout depends on outcomes. PrEP isn’t yet available in all public health facilities.

The process of providing pre-exposure prophylaxis (PrEP)

Step 1: Eligibility for PrEP

PrEP is suitable for HIV-negative individuals at high risk, including those with multiple sexual partners, engaging in transactional sex, injecting drugs or alcohol abuse, multiple STI occurrences, discordant couples, recurrent PEP users, and those engaging in anal sex.

Step 2: Screening for PrEP eligibility

After meeting criteria:

Confirm HIV-negative status.
Rule out acute HIV infection.
Assess hepatitis B status; negative indicates PrEP eligibility, positive requires management.
Assess contraindications to TDF/FTC.

Step 3: Steps to initiation of PrEP

Provide risk-reduction and adherence counselling:

Distribute condoms and educate on usage.
Develop a medication adherence plan.
Prescribe TDF (300mg) and FTC (200mg) once daily.
Initially, provide a 1-month TDF/FTC prescription with a follow-up in 1 month.
Counsel on TDF/FTC side effects.

Follow-up/monitoring clients on PrEP

Schedule a two-month follow-up after the initial visit, then quarterly.
Conduct HIV antibody tests every three months.
Perform pregnancy tests for women based on clinical history.
Review understanding of PrEP, barriers to adherence, tolerance, and side effects.
Evaluate and support PrEP adherence at each visit.
Assess for STI symptoms and treat as needed.

Guidance on discontinuing PrEP

Discontinue PrEP if:

HIV infection occurs.
Risk of HIV acquisition decreases due to lifestyle changes.
Intolerable toxicities or side effects arise.
Chronic non-adherence persists despite intervention.
Personal choice.
In sero-discordant relationships, if the positive partner achieves sustained viral load suppression (condoms should still be used consistently).

MOTHER-TO-CHILD TRANSMISSION OF HIV

Approximately one-third of the women who are infected with HIV can pass it to their babies.

Elements of Elimination of Mother-to-Child Transmission

Prong 1: Primary prevention of HIV infection for women and men of reproductive age, including adolescents.
Prong 2: Prevention of unintended pregnancies among women living with HIV, including adolescents and their partners.
Prong 3: Prevention of HIV transmission from women living with HIV to their infants, including pregnant and breastfeeding women, as well as adolescents living with HIV.
Prong 4: Provision of treatment, care, and support to women infected with HIV, their children, and their families, including women living with HIV and their families.

Cause and Time of Transmission

During pregnancy: 15-20%
During labour and delivery: 60%-70%
After delivery through breastfeeding: 15%-20%

Predisposing Factors

High maternal viral load
Depleted maternal immunity (e.g., very low CD4 count)
Prolonged rupture of membranes
Intrapartum haemorrhage and invasive obstetrical procedures
Increased risk for the first twin compared to the second twin in twin pregnancies
Premature birth poses a higher risk compared to full-term birth
Mixed feeding carries a higher risk than exclusive breastfeeding or replacement feeding

Investigations

Blood: HIV serological test
HIV DNA PCR testing of babies

Management

All HIV services for pregnant mothers are offered in the MCH clinic. After delivery, mother and baby will remain in the MCH postnatal clinic until the HIV status of the child is confirmed. Then, they will be transferred to the general ART clinic.

The current policy aims at the elimination of Mother-to-Child Transmission (eMTCT) through a continuum of care.

Management of HIV Positive Pregnant Mother

Key Interventions for eMTCT:

Routine HIV Counseling and Testing during ANC (at 1st contact. If negative, repeat HIV test in the third trimester/ labour).
Enrolment in HIV care if the mother is positive and not yet on treatment.
If the mother is already on ART, perform viral load and continue the current regimen.
ART in pregnancy, labour, post-partum, and for life – Option B+.

Recommended ARV for option B+:

One daily Fixed Dose Combination (FDC) pill containing TDF + 3TC + EFV started early in pregnancy irrespective of the CD4 cell count and continued during labor and delivery, and for life.

Alternative regimens for women who may not tolerate the recommended option are:

If TDF contraindicated: ABC+3TC+EFV
If EFV contraindicated: TDF + 3TC + ATV/r
TDF and EFV are safe to use in pregnancy.
Those newly diagnosed during labor will begin HAART for life after delivery.

Prophylaxis for Opportunistic Infections

Cotrimoxazole 960 mg 1 tab daily during pregnancy and postpartum –– Mothers on cotrimoxazole DO NOT NEED IPTp with SP for malaria.

Care of HIV Exposed Infant

HIV-exposed infants should receive care at the mother-baby care point together with their mothers until they are 18 months old. The goals of HIV-exposed infant care services are:

To prevent the infant from being HIV infected.
Among those who get infected: to diagnose HIV infection early and treat it.
Offer child survival interventions to prevent early death from preventable childhood illnesses.

The HIV Exposed Infant and the mother should consistently visit the health facility at least nine times during that period i.e (i.e., at 6, 10 and 14 weeks, then at 5, 6, 9, 12, 15 and 18 months).

Nevirapine Prophylaxis

Provide NVP syrup from birth for 6 weeks: Give NVP for 12 weeks for babies at high risk, that is breastfeeding infants who mothers:

Have received ART for 4 weeks or less before delivery; or
Have VL >1000 copies in 4 weeks before delivery; or
Diagnosed with HIV during 3rd trimester or breastfeeding period (Postnatal)

Do PCR at 6 weeks (or at first encounter after this age) and start cotrimoxazole prophylaxis

If PCR positive, start treatment with ARVs and cotrimoxazole and repeat PCR (for confirmation)
If PCR negative and the baby never breastfed, the child is confirmed HIV negative. Stop cotrimoxazole, continue clinical monitoring and do HIV serology test at 18 months.
If PCR is negative but the baby has breastfed/is breast feeding, start/continue cotrimoxazole prophylaxis and repeat PCR 6 weeks after stopping breastfeeding.
Follow up any exposed child and do PCR if they develop any clinical symptom suggestive of HIV at any time and independently of previously negative results.
For negative infants, do serology at 18 months before final discharge.

Dosages of Nevirapine

Age Group	Weight Range	Dosage	Syrup Volume (10 mg/ml)
Child 0-6 weeks	2-2.5 Kg	10 mg once daily	1 ml
Child 0-6 weeks	>2.5 Kg	15 mg once daily	1.5 ml
Child 6 weeks – 12 weeks	Any weight	20 mg once daily	2 ml

Cotrimoxazole Prophylaxis: Provide cotrimoxazole prophylaxis to all HIV exposed infants from 6 weeks of age until they are proven to be uninfected.

Child <5 kg: 120 mg once daily
Child 5-14.9 kg: 240 mg once daily

Isoniazid (INH) Preventive Therapy (IPT):

Give INH for six months to HIV-exposed infants who are exposed to TB.
Isoniazid 10 mg/kg + pyridoxine 25 mg daily
For newborn infants, if the mother has TB disease and has been on anti-TB drugs for at least two weeks before delivery, INH prophylaxis is not required.

Immunization

Immunise HIV exposed children as per national immunisation schedule.
In case of missed BCG at birth, do not give if the child has symptomatic HIV.
Avoid yellow fever vaccine in symptomatic HIV.
Measles vaccine can be given even in symptomatic HIV.

Counselling on Infant Feeding Choice

Explain the risks of HIV transmission by breastfeeding (15%) and other risks of not breastfeeding (malnutrition, diarrhoea).
Mixed feeding may also increase the risk of HIV transmission and diarrhoea.
Tell her about options for feeding, advantages, and risks.
Help her to assess choices, decide on the best option, and then support her choice.

Feeding Options

Recommended option: Exclusive breastfeeding, then complementary feeding after the child is 6 months old.
Exclusive breastfeeding stopping at 3-6 months old if replacement feeding is possible after this.
If replacement feeding is introduced early, the mother must stop breastfeeding.
Replacement feeding with home-prepared formula or commercial formula and then family foods (provided this is acceptable, feasible, safe, and sustainable/affordable).

If Mother Chooses Breastfeeding

The risk may be reduced by keeping the breasts healthy (mastitis and cracked nipples raise HIV infection risk).

Advise exclusive breastfeeding for 3-6 months.

If Mother Chooses Replacement Feeding

Counsel and teach her on safe preparation, hygiene, amounts, times to feed the baby, etc.
Follow up within a week from birth and at any visit to the health facility.

Post-exposure prophylaxis (PEP) Read More »

Management of HIV/AIDs and Hepatitis

HIV/AIDS

HIV (Human Immunodeficiency Virus) is a virus that attacks the body’s immune system, specifically the CD4 cells (T cells), which are important for immune defence.

If untreated, HIV can lead to AIDS (Acquired Immunodeficiency Syndrome), a condition where the immune system is severely weakened.

HIV is a lenti-virus (slow and long acting) and belongs to the Retroviruses group. HIV invades the helper T cells to replicate itself thereby limiting the body’s ability to fight infection . HIV is the virus that causes AIDS, and it has no cure.

Types of HIV

HIV-1: This is the most common and widespread type of HIV, accounting for the vast majority of HIV infections globally. It is highly infectious and has several subtypes (or clades), labelled A through K. HIV-1 is the primary cause of the global HIV pandemic and is more aggressive in its progression to AIDS compared to HIV-2.
HIV-2: This type is less common and primarily found in West Africa. It is less transmissible and generally progresses more slowly to AIDS than HIV-1. There are fewer subtypes of HIV-2, labelled A through H.

Characteristics of HIV/AIDS.

RNA Virus: HIV is an RNA virus that can convert its RNA into DNA using reverse transcription.
Receptor Binding: The virus has specific proteins on its surface that bind to receptors on host cells, allowing entry.
Heat Sensitivity: HIV is easily destroyed by high temperatures (around 600°F).
Human Host: HIV can only survive and replicate in humans; it dies outside the human body and when the host dies.
Immune Attack: The virus primarily targets and destroys white blood cells, especially CD4+ T cells.
Rapid Replication: HIV replicates rapidly, producing billions of new virions each day.
Disease Progression: HIV infection progresses through stages, eventually leading to AIDS if untreated.
Latency: After initial infection, HIV can hide in cells and become dormant before reactivating later.
Genetic Diversity: The virus has many subtypes and mutates quickly, making treatment and vaccine development challenging.
Immune Evasion: HIV evades the immune system by mutating and hiding within cells.
Transmission: HIV is transmitted through contact with infected bodily fluids, such as blood, semen, vaginal fluids, and breast milk.
ART Treatment: Antiretroviral therapy (ART) can control HIV, preventing the progression to AIDS and allowing individuals to live longer, healthier lives.

Epidemiology.

According to the August 2017 Uganda Population-Based HIV Impact Assessment report, the prevalence of HIV among adults aged 15 to 64 in Uganda is 6.2%, with a higher rate among females (7.6%) compared to males (4.7%). This equates to approximately 1.2 million adults living with HIV in this age group. HIV prevalence is notably higher in women living in urban areas (9.8%) than in rural areas (6.7%).

Among children aged 0-14, the HIV prevalence is 0.5%, corresponding to about 95,000 children living with HIV. The viral load suppression (VLS) rate among HIV-positive adults is 59.6%, with higher rates in females (62.9%) than males (53.6%). For children aged 0-14, the VLS rate is 39.3%. HIV prevalence peaks at 14.0% among men aged 45 to 49 and 12.9% among women aged 35 to 39. There is a significant gender disparity among young adults, with HIV prevalence nearly four times higher in females than males aged 15 to 19 and 20 to 24. Additionally, HIV prevalence is almost three times higher in adults aged 20-24 compared to those aged 15-19.

Modes of HIV Transmission

Sexual Contact:

Unprotected Vaginal Sex: HIV can be transmitted through vaginal fluids and semen during unprotected vaginal intercourse..

Blood-to-Blood Contact:

Sharing Needles: Using contaminated needles or syringes, common among intravenous drug users, can transmit HIV.
Blood Transfusions: Although rare in countries with stringent blood screening, HIV can be transmitted through infected blood transfusions.
Exposure to Contaminated Blood: Health care workers can be at risk through needle stick injuries or contact with open wounds.

Mother-to-Child Transmission:

During Pregnancy: HIV can cross the placenta from mother to baby.
During Childbirth: The baby can be exposed to HIV in the mother’s blood and vaginal fluids during delivery.
Breastfeeding: HIV can be transmitted through breast milk from an infected mother to her child.

Other Modes:

Contaminated Medical Equipment: Use of non-sterile instruments during medical or dental procedures can transmit HIV.
Organ and Tissue Transplants: Transplantation of infected organs or tissues, though rare due to screening practices, can transmit HIV.

Less Common Modes:

Tattooing and Piercing: If non-sterile needles are used, there is a risk of HIV transmission.
Contact Sports: Although extremely rare, transmission can occur if both participants have open wounds.

Factors That Facilitate Mother-to-Child Transmission of HIV

Maternal Factors:

Viral Load and Immune Status:

High Viral Load: Higher levels of HIV in the mother’s blood increase the risk of transmission to the baby.
Low CD4 Count: A weakened immune system due to low CD4 counts enhances transmission risk.
Maternal Acquisition of HIV: New HIV infections during pregnancy or lactation significantly increase transmission risk.

Infections and Inflammation:

Vaginal Infections: Infections such as bacterial vaginosis can elevate the risk of HIV transmission.
Chorioamnionitis: Inflammation of the foetal membranes due to infection can facilitate HIV transmission.

Access to Antiretroviral Therapy (ART):

Lack of ART: Mothers who do not receive ART are more likely to transmit HIV.
Poor Adherence to ART: Inconsistent use of ART reduces its effectiveness in preventing transmission.
Timing of ART Initiation: Starting ART late in pregnancy or not at all reduces its preventive benefits.

Socioeconomic Factors:

Lack of Healthcare Access: Limited access to prenatal care and HIV testing can lead to missed opportunities for prevention.
Education and Awareness: Lack of knowledge about HIV transmission and prevention strategies among pregnant women.

Nutritional Status:

Poor Maternal Nutrition: Malnutrition can weaken the mother’s immune system, increasing the risk of transmission.

Labour and Delivery Factors:

Delivery Method:

Vaginal Delivery: Higher risk of transmission compared to elective caesarean section, especially if the mother has a high viral load.
Prolonged/Difficult Labour: Increased exposure to maternal fluids during extended or complicated labour can raise the risk.

Prematurity:

Premature Birth: Prematurity can increase the risk of transmission due to underdeveloped immune systems in infants.

Membrane Rupture:

Prolonged Rupture of Membranes (PROM): Rupture lasting more than 4 hours before delivery increases the risk of HIV transmission.

Invasive Monitoring and Procedures:

Use of invasive monitoring or procedures during labour can increase the risk of HIV transmission.

Postnatal Feeding Factors:

Breastfeeding Practices:

Prolonged Breastfeeding: Longer duration of breastfeeding increases the risk of HIV transmission.
Breast Health: Conditions like sore nipples, abscesses, or mastitis can increase the risk.
Mixed Feeding: Combining breastfeeding with other foods or fluids increases transmission risk. Exclusive breastfeeding for the first 3-6 months does not show excess transmission compared to formula feeding alone.

Exclusive Breastfeeding:

Exclusive breastfeeding means providing breast milk only, without additional fluids, water, food, teats, or pacifiers, and involves on-demand feeding.

Oral Health in Infants:

Oral Thrush: Presence of oral thrush in breastfed infants can increase the risk of HIV transmission.

Phases of HIV Entry into Host Cells

Binding: The HIV virus first attaches to the CD4 receptors on the surface of the host cell, typically a type of immune cell called a CD4+ T lymphocyte. HIV’s envelope protein, gp120, specifically binds to the CD4 receptor. This interaction triggers a conformational change in gp120 that allows it to also interact with a co-receptor, usually CCR5 or CXCR4, on the host cell surface. This dual receptor binding is essential for the virus to proceed to the next step.
Fusion: After binding, the HIV viral envelope fuses with the host cell membrane, allowing the viral contents to enter the host cell. The conformational change in gp120 caused by CD4 and co-receptor binding exposes another viral protein, gp41. gp41 facilitates the merging of the viral envelope with the host cell membrane, creating a fusion pore through which the viral capsid containing the viral RNA and enzymes can enter the host cell cytoplasm.
Reverse Transcription: Once inside the host cell, the viral RNA genome is reverse transcribed into DNA. The enzyme reverse transcriptase, carried within the viral capsid, converts the single-stranded viral RNA into double-stranded DNA. This process is error-prone, leading to a high mutation rate which contributes to the virus’s ability to evade the immune system and develop drug resistance.
Integration: The newly synthesized viral DNA is integrated into the host cell’s genome. The viral DNA is transported into the host cell nucleus, where the enzyme integrase integrates it into the host cell’s DNA. This integrated viral DNA is known as a provirus and can remain dormant for a period before becoming active.
Replication: Once integrated, the viral DNA can be transcribed and translated to produce new viral RNA and proteins. The host cell’s machinery reads the integrated viral DNA and begins to produce viral RNA. Some of this RNA will serve as genomes for new viral particles, while others will be used to produce viral proteins through the process of translation.
Assembly: New viral particles are assembled within the host cell. The newly made viral RNA and proteins are transported to the host cell’s surface, where they assemble into new immature viral particles. This assembly process involves the gathering of viral components into a budding virion.
Budding: The new viral particles bud off from the host cell, acquiring an envelope from the host cell membrane in the process. The immature viral particles bud off from the host cell, during which they incorporate a portion of the host cell’s membrane as their envelope. The viral enzyme protease then cleaves certain viral precursor proteins into their mature forms, resulting in a fully mature and infectious virus ready to infect other cells.

Clinical Manifestations of HIV/AIDS

The World Health Organization (WHO) has established a staging system to classify HIV infection and disease progression:

Clinical Stage I:

Asymptomatic: No symptoms of HIV-related illness.
Persistent Generalized Lymphadenopathy: Enlargement of lymph nodes lasting more than three months.
Performance Scale 1: Asymptomatic with normal activity level.

Clinical Stage II:

Moderate Weight Loss: Less than 10% of presumed or measured body weight lost.
Minor Muco-cutaneous Manifestations: Skin conditions like seborrheic dermatitis, prurigo, or fungal nail infections.
Herpes Zoster: History of shingles within the last five years.
Recurrent Upper Respiratory Tract Infections: Such as bacterial sinusitis, tonsillitis, or otitis media.
Performance Scale 2: Symptomatic but normal activity level.

Clinical Stage III:

Severe Weight Loss: More than 10% of presumed or measured body weight lost.
Unexplained Chronic Diarrhoea: Lasting more than one month.
Unexplained Prolonged Fever: Constant or intermittent, lasting more than one month.
Oral Candidiasis: Oral thrush, a fungal infection.
Oral Hairy Leukoplakia: White patches on the tongue or mouth.
Pulmonary Tuberculosis: Active TB infection.
Severe Bacterial Infections: Such as pneumonia, pyomyositis, or bacteremia.
Acute Necrotizing Ulcerative Gingivitis: Severe gum disease.
Unexplained Anaemia, Neutropenia, or Thrombocytopenia: Abnormal blood counts.
Performance Scale 3: Bedridden for less than 50% of the day during the last month.

Clinical Stage IV:

HIV Wasting Syndrome: Weight loss of more than 10% with chronic diarrhoea or prolonged fever.
Pneumocystis Pneumonia (PCP): A severe fungal lung infection.
Toxoplasmosis of the Brain: Brain infection caused by the Toxoplasma parasite.
Cryptosporidiosis: Parasitic infection causing prolonged diarrhea.
Cytomegalovirus Infection: A viral infection affecting various organs.
Progressive Multifocal Leukoencephalopathy (PML): Brain infection causing neurological symptoms.
Lymphoma: Cancer of the lymphatic system.
Kaposi’s Sarcoma: Cancerous skin lesions caused by a herpesvirus.
HIV Encephalopathy: Cognitive and/or motor dysfunction due to HIV infection.
Atypical Disseminated Leishmaniasis: Parasitic infection affecting multiple organs.
Symptomatic HIV-Associated Nephropathy or Cardiomyopathy: Kidney or heart disease associated with HIV.
Performance Scale 4: Bedridden for more than 50% of the day during the last month.

Diagnostic Measures for HIV/AIDS

Pre and Post-Counselling and Consent: Essential for all diagnostic procedures unless in specific circumstances:

Testing of very sick, unconscious, symptomatic, or mentally ill individuals by healthcare teams for better patient management.
Routine testing for individuals likely to pose a risk of HIV infection to others, such as pregnant and breastfeeding mothers, sexual offenders and survivors, and blood or organ donors. These individuals must still be given the opportunity to know their status.

Criteria for Diagnosis: Diagnosis based on:

Clinical Staging Criteria.
Positive HIV Blood Test: Confirmation of HIV infection through serological (antibody) testing.

Testing Protocol: Testing for Adults and Children >18 Months:

Serological (Antibody) Testing: Most common method. Due to the window period between infection and antibody production, negative individuals should be re-tested after three months if exposed.
Reactive Rapid Test: Requires confirmation before diagnosis.

Diagnostic Tests

Screening Tests:

ELISA (Enzyme-Linked Immunosorbent Assay) AglAb Tests: Commonly used to screen blood donations to exclude those in the window period.

Molecular Tests:

PCR (Polymerase Chain Reaction) Tests: Nucleic-Acid Amplification Testing (NAT) detects genetic material of HIV itself, not antibodies or antigens.

Considerations: Testing should consider:

Clinical status, medical history, and risk factors of the individual being tested.
Use of tests in conjunction with patient assessment for accurate diagnosis and appropriate care.

Immediate Connection to HIV Care

If positive, immediate referral to HIV care services for management and treatment initiation.

HIV Testing Provision Protocol

Step 1: Pre-Test Information and Counseling

Provide information on HIV transmission, prevention measures, and testing benefits.
Discuss potential test results, available services, and ensure consent and confidentiality.
Conduct individual risk assessment and complete necessary documentation.

Step 2: HIV Testing

Perform blood-based testing.

For infants below 18 months: Use DNA PCR testing.
For individuals above 18 months: Conduct antibody testing as per testing algorithms.

Step 3: Post-Test Counseling (Individual/Couple)

Assess readiness to receive results and deliver them simply.
Address concerns, provide guidance on disclosure, partner testing, and risk reduction.
Offer information on basic HIV care, ART, and complete documentation.

Step 4: Linkage to Other Services

Provide information on available services and assist in completing referral forms.
Upon enrollment in services, record pre-ART enrollment numbers and transfer relevant information to ART registers.

Principles of HIV Testing Services (HTS)

Confidentiality: Ensure privacy and confidentiality of test results.
Consent: Obtain informed consent from individuals before testing.
Counselling: Offer supportive counselling before and after testing.
Correct Test Result: Ensure accuracy of test results through proper testing procedures.
Connection to Other Services: Facilitate access to appropriate services for individuals testing positive.

Linkage from HIV Testing to Prevention, Care, and Treatment

Linkage is the process of connecting individuals who test positive for HIV to the necessary services.

Successful linkage to care ensures that patients receive the services they need. For HIV-positive clients, linkage should occur promptly, within seven days if within the same facility, and within 30 days for referrals between facilities or from the community. Lay providers are recommended as linkage facilitators.

Types of Linkages:

Internal Facility Linkage: Connecting patients within the same facility.
Inter-Facility Linkage: Connecting patients to another facility.
Community-Facility Linkage: Connecting clients from the community to a health facility.

Internal Facility Linkage Steps:

Post-Test Counselling: Provide accurate results and information about available care.
Next Steps Discussion: Describe the care and treatment process, emphasizing early treatment benefits.
Address Barriers: Identify and overcome any obstacles to linkage.
Involvement: Involve the patient and family in decision-making.
Documentation: Complete client and referral forms.
Escort to Clinic: A linkage facilitator escorts the client to the ART clinic.
Enrollment: Register the patient, open an ART file, and provide preparatory counselling.
Initiation: Start ART if ready, and continue with counselling support.
Integrated Care: Coordinate other services if needed.
Follow-Up: Ensure the patient attends appointments.

Inter-Facility and Community-Facility Linkages:

Inter-Facility Linkage: Refers to connecting patients to another facility. The referring facility should track referred patients and ensure enrollment within 30 days.
Community-Facility Linkage: Connects clients from the community to a health facility. Utilize community health systems and mobilize peer leaders for outreach and follow-up. Linkage should occur within 30 days after diagnosis.

Treatment Modalities of HIV/AIDS

Treatment Modality	Description
Antiretroviral Therapy (ART)	Suppresses viral load to undetectable levels, reducing morbidity, mortality, and transmission of HIV.
Treatment of Acute Bacterial Infections	Addresses immediate bacterial infections.
Prophylaxis and Treatment of Opportunistic Infections	Prevents and manages opportunistic infections.
Maintenance of Good Nutrition	Ensures adequate nutrition to support overall health.
Immunization	Administers vaccines to prevent opportunistic infections.
Management of AIDS-Defining Illnesses	Addresses specific illnesses associated with advanced HIV infection.
Psychological Support for the Family	Provides emotional support and guidance for affected families.
Palliative Care for the Terminally Ill	Offers comfort and support for patients nearing the end of life.

Antiretroviral Drug Treatment

Goal of ART: Suppress viral load to undetectable levels, reducing morbidity, mortality, and transmission of HIV.

When to Initiate ARV:

All HIV-infected children below 12 months.
Clinical AIDS
Mild to moderate symptoms and immunosuppression.

Process of Starting ART:

Assess for opportunistic infections, defer ART if TB or cryptococcal meningitis present.
Offer ART on the same day through an opt-out approach.
If not ready for same-day initiation, agree on a timely ART preparation plan.

Available ARVs in Uganda

Drug Class	Examples
Nucleoside Reverse Transcriptase Inhibitors (NRTIs): Incorporate into the DNA of the virus, thereby stopping the building process.	Tenofovir (TDF), Zidovudine (AZT), Lamivudine (3TC), Abacavir (ABC)
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): stop HIV production by binding directly onto the reverse transcriptase enzyme, and prevent the conversion of RNA to DNA.	Efavirenz (EFV), Nevirapine (NVP), Etravirine (ETV)
Integrase Inhibitors: interfere with the HIV DNA’s ability to insert itself into the host DNA and copy itself.	Dolutegravir (DTG), Raltegravir (RAL)
Protease Inhibitors (PIs): prevent HIV from being successfully assembled and released from the infected CD4 cell.	Atazanavir (ATV), Lopinavir (LPV), Darunavir (DRV)
Entry Inhibitors: prevent the HIV virus particle from infecting the CD4 cell.	Enfuvirtide (T-20), Maraviroc

Recommended First Line Regimens in Adults, Adolescents, Pregnant Women and Children

HIV management guidelines are constantly being updated according to evidence and public policy decisions. Always refer to the latest official guidelines.

The 2022 guidelines recommend DOLUTEGRAVIR (DTG) an integrase inhibitor as the anchor ARV in the preferred first and second-line treatment regimens for all HIV infected clients; children, adolescents, men, women (including pregnant women, breastfeeding women, adolescent girls and women of child bearing potential).

Patient Category	Preferred Regimens	Alternative Regimens
Adults and Adolescents
Adults (including pregnant women, breastfeeding mothers, and adolescents ≥30Kg)	TDF + 3TC + DTG	– If DTG is contraindicated: TDF + 3TC + EFV400 – If TDF is contraindicated: TAF + FTC + DTG – If TDF or TAF is contraindicated: ABC + 3TC + DTG – If TDF or TAF and DTG are contraindicated: ABC + 3TC + EFV400 – If EFV and DTG are contraindicated: TDF + 3TC + ATV/r or ABC + 3TC + ATV/r
Children
Children ≥20Kg – <30Kg	ABC + 3TC + DTG	– If DTG is contraindicated: ABC + 3TC + LPV/r (tablets) – If ABC is contraindicated: TAF + FTC + DTG (for children >6 years and >25Kg) – If ABC and TAF are contraindicated: AZT + 3TC + DTG
Children <20Kg	ABC + 3TC + DTG	– If intolerant or appropriate DTG formulations are not available: ABC + 3TC + LPV/r granules – If intolerant to LPV/r: ABC + 3TC + EFV (in children >3 years and >10Kg) – If ABC is contraindicated: AZT + 3TC + DTG or LPV/r

Notes:

Contraindications for DTG include known diabetics, patients on anticonvulsants (carbamazepine, phenytoin, phenobarbital) – use the DTG screening tool prior to DTG initiation.
Contraindications for TDF and TAF include renal disease and/or GFR <60ml/min, weight <30Kg.
TAF can be used in subpopulations with bone density anomalies.
Children will be assessed individually for their ability to correctly take the different formulations of LPV.

Notes from Ministry of Health(Uganda)

For clients on an ABC-3TC-DTG based regimen weighing >25 kg, use the fixed-dose combination of Abacavir/Lamivudine/Dolutegravir 600/300/50 mg instead of the separate pills of Abacavir/Lamivudine 600/300 mg plus Dolutegravir 50 mg.
Use Abacavir/Lamivudine 600/300 mg for patients on the following regimens: ABC-3TC-ATV/r, ABC-3TC-LPV/r, and ABC-3TC-DRV/r.
Use the single pill of Dolutegravir 50 mg for patients on AZT-3TC-DTG based regimens.
For eligible patients on ATV/r and LPV/r, optimize to Dolutegravir.
For PrEP, while the guidelines provide options for the use of either TDF/3TC 300/300 mg or TDF/FTC 300/200 mg, use TDF/FTC 300/200 mg for PrEP in terms of programmatic implementation.

Monitoring of ARV Treatment

The monitoring of patients on antiretroviral therapy (ART) serves several purposes:

Assess Response to ART and Diagnose Treatment Failure
Ensure Safety of Medicines: Identify Side Effects and Toxicity
Evaluate Adherence to ART

Methods of Monitoring ARV Treatment

Clinical Monitoring: Involves medical history and physical examination.
Laboratory Monitoring: Includes various laboratory tests.

Viral Load Monitoring: Preferred for assessing response to ART and diagnosing treatment failure.
CD4 Monitoring: Recommended in specific scenarios.
Other Minor Laboratory Tests: Includes tests for specific indications.

Viral Load Monitoring

Preferred method for monitoring ART response. A patient who has been on ART for more than 6 months and is responding to ART should have viral suppression (VL <1000 copies/ml) irrespective of the sample type (either DBS or plasma).
Provides an early and more accurate indication of treatment failure and the need to switch from first line to second-line drugs, hence reducing the accumulation of drug resistance mutations and improving clinical outcomes.
Early and accurate indication of treatment failure.
Differentiates between treatment failure and non-adherence.
Recommended frequency: Every six months for children and adolescents under 19 years.

CD4 Monitoring

Baseline CD4 count is essential for assessing opportunistic infection risk.
Recommended for patients with high viral load or advanced clinical disease.

Other Laboratory Tests

Tests	Indication
CrAg	Screen for cryptococcal infection
Complete Blood Count (CBC)	Assess anaemia risk
TB Tests	Suspected tuberculosis
Serum Creatinine	Assess kidney function
ALT, AST	Evaluate liver function
Lipid Profile, Blood Glucose	Assess metabolic health

Problems Associated with ARV Treatment

Immune Reconstitution Inflammatory Syndrome (IRIS)

IRIS is a spectrum of clinical signs and symptoms linked to immune recovery triggered by ART. It occurs in 10–30% of individuals starting ART, usually within the first 4–8 weeks.

Serious Forms: Most severe cases happen in patients co-infected with TB, Cryptococcus, Kaposi’s sarcoma, and herpes zoster.
Risk Factors: Include low CD4+ cell count (<50 cells/mm3) at ART initiation and disseminated opportunistic infections.
Management: Usually self-limiting; treat co-infections to reduce symptoms and reassure patients to maintain ART adherence.

Steps to Reduce IRIS Development

Early HIV Diagnosis: Initiate ART before CD4 declines to below 200 cells/mm3.
Optimal Management of Opportunistic Infections: Screen and treat infections before starting ART, especially TB and cryptococcus.

ARV Drug Toxicity

Range of Toxicities: ARVs can cause mild to life-threatening side effects.
Challenges: Differentiating between ARV toxicity and HIV complications can be complex.
Management: Assess patients for side effects at every clinic visit and take appropriate actions based on severity.

Management of ARV Side Effects/Toxicities

Category	Action
Severe, Life-threatening Reactions (e.g., SJS/TEN, severe hepatitis)	– Discontinue all ARVs immediately. – Manage the medical event and substitute offending drug when stable.
Severe Reactions (e.g., Hepatitis and Anemia)	– Substitute offending drug without stopping ART.
Moderate Reactions (e.g., Gynaecomastia, Lipodystrophy)	– Substitute with a drug in the same class or different class with a different toxicity profile. – Do not discontinue ART; continue if feasible.
Mild Reactions (e.g., Headache, Minor Rash, Nausea)	– Do not discontinue or substitute ART. – Provide reassurance and support to mitigate adverse reactions. – Counseling about the events.

Adherence Preparation, Monitoring, and Support

Sustaining adherence to Antiretroviral Therapy (ART) is essential for achieving HIV viral suppression, reducing drug resistance, and improving overall health outcomes. Conversely, poor adherence is a significant contributor to treatment failure. Regular assessment and reinforcement of adherence by the clinical team are critical components of HIV care.

Adherence Preparation: Preparing people to start antiretroviral therapy (ART) is an important step to achieving ART success.

Initiation Discussion: Healthcare providers should engage patients in detailed discussions regarding their readiness and willingness to commence ART. While healthcare providers should provide necessary information and guidance, the ultimate decision to initiate ART rests with the patient or caregiver.
5 As Principles for Chronic Care: The clinical team should employ the “5 As” principles—Assess, Advise, Agree, Assist, and Arrange—to offer pre-ART adherence counselling and psychosocial support.

Steps in Preparation for ART:

Assess: Evaluate patients’ understanding of HIV, ARVs, and potential adherence barriers.
Advise: Provide patients with relevant information to empower them to enrol in treatment.
Agree on: Develop an adherence plan and identify family and community support systems.
Assist: Help patients identify and address potential barriers to adherence.
Arrange for: Schedule appointments for ARV prescription, follow-up counselling sessions, and involvement in psychosocial support groups.

Barriers to Adherence of ART

Barrier	Adolescents	Pregnant or Breastfeeding Women	Adults	Key Populations
Psychosocial issues	Peer pressure, perceived need to conform
Inconsistent daily routine	Yes
Child abuse and neglect	Yes
Stigma and discrimination	Yes	Yes	Yes	Yes
Left out of decisions/limited discussion opportunities	Yes
Limited treatment literacy or adherence counselling tools	Yes
Challenges during transition from paediatric to adolescent care	Yes
Pregnancy-related conditions (nausea/vomiting)		Yes
Suboptimal understanding of HIV, ART, eMTCT		Yes
Lack of partner disclosure/support		Yes
Non-disclosure		Yes	Yes
Gender-based violence (GBV)		Yes		Yes
Drug sharing		Yes
Service delivery barriers		Yes
Poor-quality clinical practices		Yes
Gaps in provider knowledge/training		Yes
Poor access to services		Yes
Social barriers (work schedules/job nature)			Yes
Forgetfulness			Yes
Lack of trust in providers/medicines			Yes
Lack of social support			Yes
Drug side effects			Yes
Pill burden			Yes
Inadequate information about ARVs			Yes
Alcohol and substance abuse	Yes		Yes	Yes
Provider attitude				Yes
High mobility				Yes
Lack of peer support				Yes
Lack of health worker knowledge about KPs				Yes

Methods of Monitoring Adherence to ART

Viral Load Monitoring: Considered the gold standard for assessing adherence and treatment response. It should be conducted six months after initiating treatment and annually thereafter.
Self-reporting: Rapid, inexpensive, and easily implemented, but may be subject to bias.
Pill Counting: Limited by patients potentially discarding tablets before clinic visits, but can be enhanced when combined with self-reported adherence.
Pharmacy Refill/Clinic Records: Provides reliable documentation of medication collection patterns and can indicate potential adherence challenges.

Adherence Support

Adherence support interventions should be provided to people on ART through the following interventions.

Peer counsellors: These include peer mothers in the eMTCT program, adolescent peers, expert clients and other peers as patients and caregivers usually relate better to peers.
Mobile phone calls and text messages: These should be used with the patient or caregiver consent. The patient or caregiver should provide the appropriate phone numbers to avoid accidental disclosure when messages are sent to a wrong person.
Reminder devices like calendars, pill boxes and diaries can be used by clients.
Behavioural skills training and medication adherence training: These include module based interventions and those designed to improve life skills, attitudes, behavior and knowledge.
Fixed-dose combinations and once-daily regimens: When available, health-care workers should prescribe fixed dose combinations because they reduce the pill burden. If once daily regimens are available and recommended they should be used.
Use of treatment buddies: This is an individual identified by the client to take on the role of a treatment supporter. This person reminds/gives the client their medication whenever it is time and also reminds them of their refill dates.
Peer-led dialogues: These include group discussions among clients. They could discuss the challenges they face and come up with possible solutions.

Uses of ART (Antiretroviral Therapy)

Treatment of HIV/AIDS: ART is the primary treatment for managing HIV/AIDS, helping to control the viral load and maintain the health of the immune system.
Prevention of Mother-to-Child Transmission (PMTCT): ART is crucial in preventing the transmission of HIV from an infected mother to her baby during pregnancy, childbirth, and breastfeeding.
Post-Exposure Prophylaxis (PEP): ART is used as an emergency intervention for individuals who have been potentially exposed to HIV. It must be started within 72 hours of exposure to be effective.
Pre-Exposure Prophylaxis (PrEP): ART can be taken by HIV-negative individuals at high risk of infection to prevent acquiring HIV. This is particularly useful for people with HIV-positive partners, among others.
Treatment and Support for Children: Ensuring children with HIV receive ART is essential for their growth, development, and long-term health. Adherence to the treatment regimen is crucial for its effectiveness.
Reducing Viral Load to Undetectable Levels: ART helps reduce the viral load in the body to undetectable levels, significantly lowering the risk of HIV transmission and improving overall health.
Improving Quality of Life: Effective ART can improve the quality of life for people living with HIV by reducing the incidence of opportunistic infections and other HIV-related complications.
Increasing Life Expectancy: ART has been shown to increase the life expectancy of people living with HIV, allowing them to live longer, healthier lives.
Preventing Sexual Transmission of HIV: By reducing the viral load to undetectable levels, ART can prevent the sexual transmission of HIV, a strategy known as “treatment as prevention” (TasP).
Reducing HIV-Related Stigma and Discrimination: Successful ART can help reduce stigma and discrimination associated with HIV by enabling individuals to lead healthy, productive lives, thereby changing perceptions about the disease.
Managing Co-Infections: ART can help in managing co-infections such as hepatitis B and C, tuberculosis, and other conditions that are common in people living with HIV.

HIV/AIDS Prevention

In Uganda, the HIV epidemic is driven by multiple behavioural, biomedical and structural factors. There is thus no single HIV prevention intervention that is sufficient to prevent all HIV transmissions.

Behavioral Change and Risk Reduction Interventions

Delaying sexual debut, reducing unsafe sex practices, discouraging cross-generational sex.

Types of Behavioural Change:

Service Delivery: Ensuring designated focal persons, staff training, and outreach programs.
Risk Assessment: Offering HIV testing, assessing sexual behavior, and providing Socio-Behavioral Change Communication (SBCC).
Condom Promotion: Encouraging condom use, addressing misconceptions, and overcoming barriers.

Biomedical Prevention Interventions

Key Interventions:

EMTCT: EMTCT programs aim to prevent the transmission of HIV from an HIV-positive mother to her child during pregnancy, labor, delivery, or breastfeeding.
Safe Male Circumcision (SMC): Studies have shown that SMC can reduce the risk of heterosexual men acquiring HIV by approximately 60%. SMC also helps in reducing the risk of other sexually transmitted infections (STIs), such as human papillomavirus (HPV) and herpes simplex virus type 2 (HSV-2).
ART: Reduces the amount of HIV in the blood to undetectable levels. People with an undetectable viral load have effectively no risk of transmitting HIV sexually.
PEP: PEP involves taking antiretroviral medicines after potential exposure to HIV to prevent infection. Must be started within 72 hours after exposure, up to usually 28 days, such as occupational exposure (e.g., needlestick injury) or non-occupational exposure (e.g., unprotected sex, sexual assault).
PrEP: PrEP is a daily medication taken by HIV-negative individuals to prevent HIV infection. Includes individuals with HIV-positive partners, people who inject drugs, and those with high-risk sexual behaviors. When taken consistently, PrEP reduces the risk of HIV infection from sexual contact by about 99% and from injection drug use by at least 74%.
Blood transfusion safety: Ensuring that blood and blood products are safe from HIV and other infections.Testing blood donors for HIV and other bloodborne pathogens. Implementing strict protocols for the collection, testing, and transfusion of blood.
STI screening and treatment: Regular screening and timely treatment of sexually transmitted infections (STIs) to prevent the spread of HIV. STIs can increase the susceptibility to and transmission of HIV. Encouraging routine health check-ups and screenings, particularly for high-risk populations. Providing prompt treatment for any detected STIs to reduce complications and transmission risk.

Post-exposure prophylaxis (PEP)

Click Here

Management of HIV/AIDs and Hepatitis Read More »

CONFLICT RESOLUTION

Conflict is an expressed struggle between at least two interdependent parties.

A conflict is any discontent or dissatisfaction that affects the organizational performance.

A conflict is a situation when the interests, needs, goals or values of involved parties interfere with one another.

Conflict is defined as the consequence of real or perceived differences in mutually exclusive goals, values, ideas, attitudes, beliefs, feelings or actions.

A conflict is not the same as a problem. It only becomes a problem after failing to resolve it.

Types/Levels of conflicts

Intrapersonal /personal conflict: This conflict occurs within us. They occur when we are not happy with ourselves or when we are torn between choices we need to make or when we are frustrated with our goals/accomplishments. These conflicts often lead to conflict with others.
Interpersonal conflict: This conflict happens between 2 or more people with differing values, goals and beliefs. Most common type of conflict. Interpersonal conflicts usually arise in the workplace due to natural differences in human personality, human needs, beliefs or work ethics. Has a tendency of resolving itself because conflicting parties are not able to continue in a tense situation for a long time (hence time is a healing factor).
Social / inter group conflict: This conflict happens between 2 or more groups of people. These could be departments or organizations.

General causes of conflicts

Communication: In hospitals, conflicts often arise due to unclear, infrequent or ineffective communication, can lead to misunderstandings, frustration. This can manifest through lack of feedback, misunderstandings, withholding information, criticism, etc. For instance, A doctor may not communicate effectively with a nurse about a patient’s care plan, leading to confusion and potential errors.
Personal causes of conflict: Ego, personal biases, and lack of empathy can contribute to conflicts among healthcare professionals. For example, differences in personalities or perceived disrespect between nurses and physicians may lead to friction.
Process causes of conflict: Disagreements about how things should be done can lead to conflict For instance, Two nurses may disagree on the best way to manage a patient’s pain, leading to a heated debate and delayed treatment.
Preferred methods: Healthcare professionals may clash over their preferred methods of performing clinical procedures or administering patient care. Individuals may believe their way of doing things is superior and insist others follow their methods For instance, A senior doctor may insist on using a specific surgical technique, even though newer, more efficient methods are available.
Sharing or scarcity of resources: Limited resources, such as personnel, budgets, and medical equipment, competition and conflict can arise. For example, Two departments may compete for the same operating room time, leading to delays and frustration for both teams.
Personality style differences: Differences in personality like Introverts vs. extroverts, Judgers vs. perceivers, values, attitudes, needs, expectations, perceptions, and social styles can lead to misunderstandings and conflict.
Power struggles: The desire for control and power can be a significant source of conflict. For example, Individuals may compete for promotions, leadership roles, or recognition, others may use their power to manipulate or intimidate others.
Values: Differences in values can lead to conflict when individuals judge others based on their own beliefs. For instance, Ethical dilemmas, Individuals may disagree on the right course of action in ethically challenging situations, A doctor may refuse to perform an abortion due to religious beliefs, leading to conflict with a patient who requests the procedure.
Lack of role clarification/job description: Unclear job roles or responsibilities can lead to conflicts among hospital staff members over task assignments or accountability for patient care outcomes.
Poor processes: IInefficient or outdated processes can create frustration and delays.
Lack of performance standards: Unclear expectations can lead to confusion and conflict over performance evaluations.
Inadequate resources: Shortages of staff, supplies, or funding can exacerbate conflicts over workload distribution, resource allocation, or access to essential healthcare services.
Unreasonable time constraints: Tight schedules or unrealistic deadlines may lead to conflicts among healthcare professionals over competing priorities or work-life balance issues.
Lack of cooperation: Individuals may be unwilling to work together or share information, leading to conflict.
Lack of trust: Mistrust among hospital staff members can hinder effective communication, teamwork hence conflicts.
Poorly defined goals: Ambiguity or inconsistency in organizational objectives can fuel conflicts over strategic direction, departmental priorities, or performance expectations.
Inadequate skills: Skill gaps or deficiencies among healthcare professionals can lead to conflicts over competency, proficiency, or training needs, affecting patient care quality and safety.
Threat to status: Perceived challenges to professional status or authority can trigger conflicts among healthcare professionals seeking recognition, respect, or influence within the hospital hierarchy.
Unpredictable policies: Inconsistencies or frequent changes in hospital policies, procedures, or protocols may fuel conflicts over compliance, adherence, or interpretation, causing confusion and frustration among staff members.
Resistance to change: Conflicts may arise when healthcare professionals resist organizational changes, innovations, or quality improvement initiatives, citing concerns over workflow disruption, job security, or patient care implications.
Stress: High levels of job-related stress or burnout among healthcare professionals can exacerbate conflicts in hospital settings, affecting morale and productivity.

STAGES OF CONFLICT

Latent conflict.
Conflict Emergency.
Conflict Escalation.
Hurting/Stalemate.
De-escalation
Settlement/ Resolution
Post conflict peace building and reconciliation.

At Nurses Revision hospital, the surgical ward is abuzz with activity. Nurse Sarah, a seasoned veteran with years of experience, firmly believes in the traditional method of patient care documentation. She prefers to rely on her clinical judgment when providing care to her patients. Sarah is accustomed to documenting patient assessments and interventions in their files, without the structure of formal nursing care plans.

On the other hand, Nurse Emily, a recent graduate eager to embrace evidence-based practices, advocates for the use of nursing care plans. Emily believes that standardized care plans provide a comprehensive framework for organizing patient information and ensuring consistency in care delivery.

1. Latent Conflict: People have different ideas, values, personalities and needs, which can create situations where others agree with their thoughts or actions. This in itself is not a problem, unless an event occurs to expose these differences

Initially, there is no conflict between Sarah and Emily regarding their documentation practices. However, small differences in their approaches to patient care begin to surface. Sarah views nursing care plans as bureaucratic and time-consuming, while Emily sees them as essential tools for improving quality of care. These differences in opinion create the potential for conflict but remain latent until a triggering event occurs.

2. Conflict Emergence: At the emergence stage, conflict starts to set in as the parties involved recognize that they have different ideas and opinions on a given topic. The differences cause discord and tension. The conflict may not become apparent until a “triggering event” leads to the emergency (or beginning) of the obvious conflict.

The triggering event occurs when the hospital announces that it will be transitioning to using nursing care plans. Tensions rise as Sarah and Emily clash over the use of nursing care plans, with Sarah feeling threatened by the prospect of change and Emily frustrated by Sarah’s resistance.

3. Conflict Escalation: If the parties involved in a conflict cannot come to a resolution, the conflict may escalate. When a conflict escalates, it may draw more people into the situation, heightening any already existing tension. The escalation stage is intense and during this stage people pick sides and view their opponents as the enemy.

As the conflict escalates, other nurses on the surgical ward are drawn into the debate over documentation practices. Nurses who prefer the old way of documentation form a group to oppose the change. The atmosphere on the ward becomes heightened, with nurses taking sides and viewing their colleagues’ perspectives as incompatible with their own.

4. Stalemate (Hurting): Stalemate is the most intense stage and arises out of a conflict escalating. During the stalemate stage, the conflict has spiraled out of control to a point where neither side is in a position to agree to anything. By this point, participants are not willing to back down from their stances, and each side insists that its beliefs are ultimately right.

The conflict reaches a stalemate as Sarah and Emily dig in their heels. The conflict reaches a point where neither side is willing to compromise, relationships between nurses are severely damaged and the conflict is affecting the nurses’ ability to provide quality care.

5. De-Escalation: Even the most intense conflicts calm down at some point, as one or more of the persons involved in the conflict realize they are not likely to reach a conclusion if they continue with their unwillingness to look at the conflict from all sides. During this stage, parties begin to negotiate and consider coming up with a solution.

Recognizing the detrimental impact of the conflict on patient care and team morale, Nurse Manager Alex intervenes to facilitate a resolution. Alex organizes a series of facilitated discussions and training sessions to address the concerns of both Sarah and Emily. Through open dialogue and education about the benefits of nursing care plans, Alex helps the nurses find common ground and understand the importance of adapting to change for the collective good of the team and patients.

6. Dispute Settlement/Resolution: After hearing from all parties involved in the conflict, participants are sometimes able to come up with a resolution for the problem they are facing. As an administrator, you may have to work with the involved parties to settle the conflict very well by shifting the focus to what is really important.

As a result of Alex’s intervention, Sarah and Emily come to a mutual agreement to adjust on their practices. They agree to add elements of nursing care plans into their documentation. Hospital provides training and also already printed care plans which meet the needs of all the nurses.

7. Post-Conflict/Peace Building: If the parties reach a solution, it’s necessary to repair the relationships that may have been damaged during the escalated conflict because It’s more likely that the participants used harsh words or even fought while in the midst of the conflict.

With the conflict resolved, the nurses on the surgical ward focus on rebuilding trust among team members. They participate in team-building activities and engage in discussions to strengthen their relationships and their commitment to care.

Latent conflict.

CONFLICT MANAGEMENT

Conflict management is the practice of identifying and handling a conflict in a sensible, fair and efficient manner.

APPROACHES USED IN CONFLICT MANAGEMENT

The conflict styles.

Competition (win-lose situation)
Accommodation (win-win situation)
Avoidance (lose-lose situation)
Compromise (lose-lose situation)
Collaboration (win-win situation)

The “interest-based relational approach”.
The tool-conflict resolution process.

The conflict resolution styles.

1. Competition.(win-lose situation);

Take a firm stand, and know what you want. Operate from a position of power, drawn from things like position, rank, expertise, or persuasive ability. This style can be useful when;

There is an emergency and a decision needs to be made fast.
The decision is unpopular.
Defending against someone who is trying to exploit the situation selfishly.

However it can leave people feeling bruised, unsatisfied and resentful when used in less urgent situations.

2. Collaboration(win-win situation);

Try to meet the needs of the parties involved. Be highly assertive, cooperate effectively and acknowledge that everyone is important. This style is useful

When you need to bring together a variety of viewpoints to get the best solution.
When there have been previous conflicts in the group.
When the situation is too important for a simple trade-off.

3. Compromising:(lose-lose situation);

Try to find a solution that will at least partially satisfy everyone. Everyone is expected to give up something. Compromise is useful,

When the cost of conflict is higher than the cost of losing ground.
When equal strength opponents are at a standstill.
When there is a deadline looming.

4. Accommodating:(lose-win situation);

This style indicates a willingness to meet the needs of others at the expense of the person’s own needs. The accommodator often knows when to give in to others, but can be persuaded to surrender a position even when it is not warranted. This person is not assertive but is highly cooperative. Accommodation is appropriate,

When the issues matter more to the other party.
When peace is more valuable than winning.
When you want to be in a position to collect on this “favour” you gave.

However people may not return favours, and overall this approach is unlikely to give the best outcomes.

5. Avoidance (lose-lose situation);

Seek to evade the conflict entirely, delegate controversial decisions, accept default decisions, and don’t hurt anyone’s feelings. This style can be appropriate,

When victory is impossible.
When the controversy is trivial.
When someone else is in a better position to solve the problem.

However in many situations this is a weak and ineffective approach to take.

Interest-Based Relational Approach

The Interest-Based Relational Approach (IBRA) is a collaborative conflict resolution method that focuses on building relationships and understanding the underlying interests of all parties involved. It aims to find solutions that meet the needs of everyone involved while preserving and strengthening relationships. It involves;

Making sure that good relationships are the first priority.
Keeping people and problems separate
Paying attention to the interests that are being presented.
Listening to what both parties have to say.
Set out the facts
Explore options and solutions together.

Remember these,

Assure privacy
Empathize than sympathize
Listen actively
Maintain equity
Focus on issue, not on personality
Avoid blame
Identify key theme
Re-state key theme frequently
Encourage feedback
Identify alternate solutions
Give your positive feedback
Agree on an action plan

USING THE TOOL: A CONFLICT RESOLUTION PROCESS

This involves the following steps,

1. Set the scene.

Make sure that people understand that the conflict may be a mutual problem, which may be best resolved through discussion and negotiation rather than through raw aggression.
If you are involved in the conflict, emphasize the fact that you are presenting your perception of the problem. Use active listening skills to ensure you hear and understand other’s positions and perceptions.
And make sure that when you talk, you’re using an adult, assertive approach rather than a submissive or aggressive style.

2. Gather information.

Here you are trying to get to the underlying interests, needs, and concerns. Ask for the other person’s viewpoint and confirm that you respect his or her opinion and need his or her cooperation to solve the problem.
Try to understand his or her motivations and goals, and see how your actions may be affecting these.

3. Agree about the problem.

This sounds like an obvious step, but often different underlying needs, interests and goals can cause people to perceive problems very differently. You’ll need to agree on the problems that you are trying to solve before you’ll find a mutually acceptable solution.

Sometimes different people will see different but interlocking problems – if you can’t reach a common perception of the problem, then at the very least, you need to understand what the other person sees as the problem.

4. Get possible solutions.

If everyone is going to feel satisfied with the resolution, it will help if everyone has had fair input in generating solutions. Brainstorm possible solutions, and be open to all ideas, including ones you never considered before.

5. Negotiate the solution.

By this stage, the conflict may be resolved: Both sides may better understand the position of the other, and a mutually satisfactory solution may be clear to all.
However you may also have uncovered real differences between your positions. This is where a technique like win-win negotiation can be useful to find a solution that, at least to some extent, satisfies everyone.
There are three guiding principles here: Be Calm, Be Patient, and Have Respect.

How to prevent conflicts

1. Communicate effectively:

Be clear and concise in your communication. Avoid using jargon or technical terms that your team members may not understand.
Be open and honest. Share your thoughts and feelings openly, and encourage your team members to do the same.
Listen actively. Pay attention to what your team members are saying, and try to understand their point of view.
Ask questions. If you’re unsure about something, ask for clarification.
Give feedback. Let your team members know how they’re doing, and offer constructive feedback when needed.

2. Meet frequently:

Regular team meetings provide an opportunity to discuss issues, share updates, and build relationships.
Encourage open communication during meetings, and make sure everyone has a chance to speak.
Use meetings to brainstorm solutions to problems and conflicts.

3. Allow your team to express openly:

Create a safe space where team members feel comfortable sharing their thoughts and feelings.
Encourage open communication by being a good listener and showing empathy.
Address concerns promptly and fairly.

4. Share objectives:

Make sure everyone on the team understands the team’s goals and objectives.
Communicate how individual roles contribute to the overall goals.
Celebrate successes together.

5. Have a clear and detailed job description:

Clear job descriptions help to prevent conflicts by outlining expectations and responsibilities.
Review job descriptions regularly to ensure they are up-to-date.

6. Distribute tasks fairly: