FACTORS ASSOCIATED WITH THE UPTAKE OF AMBULANCE SERVICES BY COMMUNITY MEMBERS IN LUBAGA DIVISION, KAMPALA - UGANDA

Abstract

ABSTRACT Introduction: Access to Emergency Medical Services (EMS), particularly ambulance services, remains a critical component of health care delivery worldwide. In Uganda, and specifically in Lubaga Division of Kampala District, ambulance utilization is significantly low, with only 6.3% of emergency cases between 2020 and 2024 reaching hospitals via ambulance. This is below the national average and has been linked to poor emergency outcomes. Despite governmental interventions such as establishing EMS policies, investing in infrastructure, and offering free ambulance services, uptake remains insufficient. Factors contributing to this include socio-economic barriers, perceptions, awareness levels, and systemic limitations in availability and access. Aim: The study aimed at determining the factors associated with the uptake of ambulance services by community members in Lubaga Division, Kampala District. Methods: The study will adopt a descriptive cross-sectional design employing both quantitative and qualitative approaches. A total of 438 community members from selected parishes in Lubaga Division will be done using systematic and simple random sampling techniques. Data collection tools will include structured questionnaires and interview guides administered to both community members and key informants. Quantitative data was analyzed using SPSS version 26 through univariate, bivariate, and multivariate methods, including logistic regression analysis, while qualitative data will undergo thematic analysis.

Results: Out of 438 participants, only 32.9% had ever used ambulance services. Of these, 63.2% paid for the service, primarily for accidents (51.4%), Overall attitudes and perceptions were predominantly negative (100% and 99.3%, respectively), and only 32.0% were knowledgeable about ambulance services. Factors associated with uptake of ambulance services included participants aged 40+ were significantly more likely to use ambulance services (aOR = 3.03, 95% CI: 1.55–5.90, p = 0.001), as were those with knowledge of the designated ambulance number (aOR = 5.90, 95% CI: 3.38–10.27, p < 0.001), those who had ever needed ambulance services (aOR = 2.40, 95% CI: 1.39–4.14, p = 0.002), and those who were knowledgeable about ambulance services (aOR = 2.13, 95% CI: 1.16–3.91, p = 0.015). Additionally, participants who believed ambulance services were reliable were more likely to use them (aOR = 1.84, 95% CI: 1.04–3.27, p = 0.038), and those who had lost a family member/relative due to an ambulance wasn’t available or delayed to come were also more likely to utilize the service (aOR = 2.23, 95% CI: 1.15–4.34, p = 0.018). Additionally, 33.9% needed an ambulace for the family member or relative but did not call one because of: high costs (37.7%), delays of the ambulances coming (32.5%), and lack of trust (5.3%). Conclusion: Despite widespread recognition of their importance, ambulance services in Lubaga Division are underutilized. Barriers to access included low awareness of access procedures, high out-of-pocket costs, unreliable service delivery, and persistent negative and attitude and perceptions. Significant predictors of uptake include older age, prior need, trust in service reliability, and knowledge of access procedures.