Showing papers by "Makerere University published in 1998"

Complementarity and the use of indicator groups for reserve selection in Uganda

Abstract: A major obstacle to conserving tropical biodiversity is the lack of information as to where efforts should be concentrated. One potential solution is to focus on readily assessed indicator groups, whose distribution predicts the overall importance of the biodiversity of candidate areas1,2. Here we test this idea, using the most extensive data set on patterns of diversity assembled so far for any part of the tropics. As in studies of temperate regions2,3,4,5,6,7,8, we found little spatial congruence in the species richness of woody plants, large moths, butterflies, birds and small mammals across 50 Ugandan forests. Despite this lack of congruence, sets of priority forests selected using data on single taxa only often captured species richness in other groups with the same efficiency as using information on all taxa at once. This is because efficient conservation networks incorporate not only species-rich sites, but also those whose biotas best complement those of other areas9,10,11. In Uganda, different taxa exhibit similar biogeography, so priority forests for one taxon collectively represent the important forest types for other taxa as well. Our results highlight the need, when evaluating potential indicators for reserve selection, to consider cross-taxon congruence in complementarity as well as species richness.

Biome reconstruction from pollen and plant macrofossil data for Africa and the Arabian peninsula at 0 and 6000 years

Abstract: Biome reconstruction from pollen and plant macrofossil data provides an objective method to reconstruct past vegetation. Biomes for Africa and the Arabian peninsula have been mapped for 6000 years sp and provide a new standard for the evaluation of simulated palaeovegetation distributions. A test using modern pollen data shows the robustness of the biomization method, which is able to predict the major vegetation types with a high confidence level. The application of the procedure to the 6000 years data set (pollen and plant macrofossil analyses) shows systematic differences from the present that are consistent with the numerous previous regional and continental interpretations, while providing a more extensive and more objective basis for such interpretations. Madagascar, eastern, southern and central Africa show only minor changes in terms of biomes, compared to present. Major changes in biome distributions occur north of 15 degrees N, with steppe in many low-elevation sites that are now desert, and temperate xerophytic woods/scrub and warm mixed forest in the Saharan mountains. These shifts in biome distributions, imply significant changes in climate, especially precipitation, between 6000 years and present, reflecting a change in monsoon extent combined with a southward expansion of Mediterranean influence.

A randomized, community trial of intensive sexually transmitted disease control for AIDS prevention, Rakai, Uganda.

Abstract: An ongoing (1994-98) randomized community-based trial in Ugandas Rakai District is assessing the assumption that intensive sexually transmitted disease (STD) control efforts result in marked declines in HIV/AIDS prevalence. Described in this article are the project design and findings of the first-round baseline survey. 56 communities were grouped into 10 clusters designed to encompass social/sexual networks and clusters within blocks were randomly assigned to the intervention or control arm. All consenting permanent residents of the district are visited in their homes at 10-month intervals where they are administered extensive questionnaires provide urine and vaginal swab samples and are offered mass treatment regardless of symptoms or laboratory testing (single oral dose STD treatment in the intervention arm and anthelmintics and iron folate in the control arm). Both groups receive identical health education condom promotion and serologic counseling services. In the first round of home visits 5834 intervention and 5784 control arm subjects were enrolled representing about 90% of eligible adults. The groups were comparable in terms of sociodemographic and behavioral characteristics and baseline rates of HIV and STDs. 16.9% of subjects were HIV-positive 10.0% had syphilis 23.8% of women had trichomonas and 50.9% had bacterial vaginosis. Detailed STD assessment is expected not only to document the relationship between STD control and HIV but also to identify which STDs confer the greatest population attributable risk for HIV transmission facilitating targeted control efforts in the future.

Risk Factors for Early Childhood Malnutrition in Uganda

Abstract: Objective. To assess the dietary and environmental factors influencing stunting and other signs of poor nutritional status of children Methods. The study was a cross-sectional survey using stratified multistage random sampling to select households with a child Results. A large minority (21.5%) of the children surveyed were found in poor health after clinical examination: 3.8% being classified as suffering from kwashiorkor and 5.7% with marasmus. A high proportion of children were stunted (23.8%), underweight (24.1%), or had low MUAC (21.6%). Although rural living, poor health, the use of unprotected water supplies, lack of charcoal as fuel, lack of milk consumption, and lack of personal hygiene were shown as risk factors for marasmus and underweight, different factors were found to be associated with risk of stunting and low MUAC, despite these three parameters being significantly correlated. For stunting the risk factors were: age of the child, poor health, prolonged breastfeeding (from >18 months to Conclusions. This first account of dietary and environmental risk factors involved in the etiology of early childhood malnutrition in Uganda indicates differences in risk factors for marasmus and underweight compared with stunting and low MUAC. The high prevalence of malnutrition and current infection of children in this survey suggests poor immune function as a result of inadequate nutrition.

The use of formal and informal services for antenatal care and malaria treatment in rural Uganda.

Abstract: The study aimed to analyze reasons for the use or non-use of antenatal care services and malaria treatment among pregnant women living in rural areas in Uganda. Focus group discussions with pregnant women, in-depth interviews with key informants (Traditional Birth Attendants (TBAs) and health workers) and a structured questionnaire administered to pregnant women were used to collect the relevant information. Antenatal care attendance was irregular and few women knew that the purpose of attending antenatal care was to monitor both the growth of the baby and the health status of the woman. Parity significantly influenced antenatal care attendance, but level of education, religion and marital status did not. Fifty-five per cent of the women stated that they had delivered outside the formal health delivery system despite antenatal care attendance. All women in their second pregnancy had delivered their first child in the village, despite TBA training to the contrary. Malaria as perceived by pregnant women is common and multiple health service providers are used for its treatment. About 66% of the mothers reported having suffered from malaria during the current pregnancy; of these more than half had received treatment outside the formal health delivery system. Self-treatment with drugs bought from ordinary shops was commonly reported. Nearly all women (93.3%) knew about the antimalarial drug chloroquine and 83% thought that it was used for the treatment of malaria, not for its prevention. Some women believed that the drug could cause abortion. Health seeking behaviour was influenced by several factors, including the perceived high cost of antenatal care services, of conducting a delivery and treatment, and perceived inadequacy of services provided by the formal health system. Inadequacy of formal health services was perceived by users to be partly due to understaffing and to irregular supply of essential drugs. Intensive health education to pregnant women on the safety of chloroquine use in pregnancy, the importance and the need for regular antenatal care attendance are recommended. In addition, training of more TBAs and continued educational efforts to upgrade their knowledge, regular and adequate supply of essential drugs, and free health services for high-risk groups such as pregnant women are recommended to improve antenatal care services and drug prophylaxis use in pregnancy.

A prospective study of community-acquired bloodstream infections among febrile adults admitted to Mulago Hospital in Kampala, Uganda.

Abstract: Septicemia often causes death in HIV-infected adults in developing countries. The prevalence and etiology of community-acquired bloodstream infections (BSI) were measured among 299 consecutive febrile adult medical admissions to Mulago Hospital Kampala Uganda during 4 months in 1997. The 299 patients in the final study sample were of median age 30 years of whom 159 (53%) were male and 227 (76%) were HIV-1-seropositive. The overall prevalence of bacteremia or fungemia was 24% with 27% of HIV-infected patients and 15% of uninfected patients being bacteremic. 28 people were infected with Mycobacterium tuberculosis 15 with Streptococcus pneumoniae and 13 with Salmonella species; these were the most frequent isolates. All Salmonella and mycobacterial isolates were recovered from HIV-infected patients. Pneumococcal bacteremia was not associated with HIV seropositivity. M. avium complex and M. simiae were isolated from 2 patients infected with HIV. 13% of febrile HIV-infected adults who presented for hospitalization were mycobacteremic. These findings suggest that bacteremia and disseminated tuberculosis (TB) are frequent causes of morbidity in febrile HIV-infected Ugandan adults. Initial empiric antibiotic coverage in this setting should target pneumococcus and gram-negative enteric bacilli while patients presenting with chronic cough should be evaluated for TB.

Impact of human immunodeficiency virus type-1 infection on the initial bacteriologic and radiographic manifestations of pulmonary tuberculosis in Uganda

Abstract: CADRE: Le Centre de Traitement de la Tuberculose a Kampala, Ouganda. OBJECTIF : Evaluer l'impact de la co-infection par le virus de l'immunodeficience humaine (VIH) sur la presentation bacteriologique et radiologique de la tuberculose en Ouganda, un pays ou les taux d'infection par Mycobacterium tuberculosis et par VIH sont eleves. SCHEMA: Comparer les caracteristiques de base des adultes, infectes ou non par le VIH, et presentant une tuberculose pulmonaire de premiere atteinte recemment diagnostiquee et confirmee par la culture ; ces adultes etaient examines en vue de leur participation a un essai prospectif et randomise de traitement de la tuberculose. RESULTATS : Les examens directs de l'expectoration negatifs ou paucibacillaires (bacilles tres rares ou rares) s'averent plus frequents chez les patients infectes par le VIH et se presentant avec une tuberculose pulmonaire (P = 0,007). Les cultures d'expectorations necessitant une incubation de 7 a 8 semaines avant la positivite s'averent plus frequentes chez les sujets infectes par le VIH que chez les non-infectes (P < 0,01). Les infiltrats affectant les champs pulmonaires inferieurs et les infiltrats pulmonaires diffus sont plus frequents chez les sujets infectes par le VIH. Les taux de presentation radiologique atypique et de maladie cavitaire sont comparables entre les sujets VIH ( + ) et VIH ( - ); toutefois, les maladies atypiques sont rencontrees plus frequemment chez les sujets VIH ( + ) dont le test tuberculinique est faiblement positif ou meme negatif (PPD = 0 mm). CONCLUSION: La co-infection par le VIH va de pair avec une frequence plus elevee d'examens directs de l'expectoration negatifs ou paucibacillaires. Les differences dans les rendements diagnostiques de la microscopie et de la culture entre les sujets VIH ( + ) et VIH ( - ) sont faibles et n'influencent pas a notre avis de facon significative l'interet de ces tests importants de diagnostic dans les pays en developpement. Le rendement diagnostique peut etre optimise par l'examen de plus d'un echantillon de crachat et par le suivi des cultures pendant 8 semaines entieres. Les infiltrats des lobes superieurs et les cavites sont toujours les presentations radiologiques les plus frequentes de la tuberculose pulmonaire chez les adultes des pays a haute prevalence de tuberculose, qu'ils soient ou non infectes par le VIH.

The avifauna 23 years after logging in Kibale National park, Uganda

Abstract: The bird fauna of logged and unlogged forest in Kibale National Park, western Uganda were studied and comparisons made. Species diversity and richness were higher in the logged areas. A single species, the Yellow-whiskered Greenbul Andropadus latirostris dominated in the logged compartment. However, the majority of individual birds found in the logged forest were generalist or forest-edge species. Over 84% of the forest interior specialist species that occurred in primary forest had recolonized or persisted in the logged forest; however, there were seven out of 48 understorey forest specialists that had not done so. Although there was moderate species overlap between the two habitats, the logged forest compartment had not fully recovered from logging after 23 years.

The effects of ivermectin on onchocercal skin disease and severe itching: results of a multicentre trial

Abstract: objective To determine the effects of ivermectin in annual, 3-monthly and 6-monthly doses on onchocercal skin disease (OSD) and severe itching. method A multicentre, double-blind placebo controlled trial was conducted among 4072 residents of rural communities in Ghana, Nigeria and Uganda. Baseline clinical examination categorized reactive skin lesions as acute papular onchodermatitis, chronic papular onchodermatitis and lichenified onchodermatitis. Presence and severity of itching was determined by open-ended and probing questions. Clinical examination and interview took place at baseline and each of 5 subsequent 3-monthly follow-up visits. results While prevalence and severity of reactive lesions decreased for all 4 arms, those receiving ivermectin maintained a greater decrease in prevalence and severity over time. The difference between ivermectin and placebo groups was significant for prevalence at 9 months and for severity at 3 months. Differences between placebo and ivermectin groups were much more pronounced for itching. From 6 months onward, the prevalence of severe itching was reduced by 40–50% among those receiving ivermectin compared to the trend in the placebo group. conclusion This is an important effect on disease burden as severe itching is for the affected people the most troubling complication of onchocerciasis. The difference among regimens was not significant, and the recommended regimen of annual treatment for the control of ocular onchocerciasis appears also the most appropriate for onchocerciasis control in areas where the skin manifestations predominate. The final determination of the effect on skin lesions requires a longer period of study.

The social background of Makerere University students and the potential for cost sharing

Abstract: The social background of Makerere students was analysed in order to gain some insight in the distribution of scarce higher education opportunities in Uganda and assess the ability of the students to finance part of their education cost in the process of massifying higher education without diluting the quality of instruction. The findings were that students from well to-do learned families in the more prosperous districts were enjoying the existing performance based subsidies (PBS) and the privately sponsored places and programs (PSPP) which Makerere University had introduced. The interaction of the social and school system acted to reinforce the inequalities at all stages starting from family background, the primary and secondary schools as well as the universities under the present PBS system of admission.

Parasitological detection of Trypanosoma brucei gambiense in serologically negative sleeping-sickness suspects from north-western Uganda.

Abstract: Forty-five parasitologically confirmed cases of sleeping sickness were diagnosed in north-western Uganda using a combination of two or three techniques. Forty of the cases were positive by the card...

Effect of dried Gliricidia sepium leaf supplement on feed intake, digestibility and nitrogen retention in sheep fed dried KW4 elephant grass (Pennisetum purpureum) ad libitum

Abstract: A feeding experiment was conducted to study the effects of supplementation with dried Gliricidia sepium leaves on dry matter (DM) intake, digestibility and nitrogen retention in sheep fed KW4 elephant grass. Four mature rams were fed elephant grass ad libitum supplemented with four levels of gliricidia leaves (0, 4, 8 and 12 g DM kg−1 lwt day−1) in a 4 × 4 Latin square design. Supplementation with gliricidia leaves decreased elephant grass DM intake (g DM day−1 or g DM kg−1 BW0.75 day−1). However, the effect of supplementation on total DM intake of the rations was not significant (P >; 0.05). Total crude protein intake significantly (P < 0.001) increased with increasing levels of gliricidia supplementation. Total DM digestibility and body weight changes were significantly (P < 0.05) improved by gliricidia supplementation; with the highest digestibility coefficient (60.5%) and body weight gain (89.3 g/day) obtained at 8 g DM kg−1 lwt day−1. Gliricidia supplementation significantly (P < 0.001) improved nitrogen intake, absorbed nitrogen and retained nitrogen but with no significant difference at 8 and 12 g DM kg−1 lwt day−1 level of supplementation. The highest efficiency of N retention by sheep (44.9%) was obtained at 8 g DM kg−1 lwt day−1 level of gliricidia supplementation. The results indicated that supplemention of KW4 elephant grass with small quantities of gliricidia leaves up to 8 g DM kg−1 lwt day−1 enhance utilisation efficiency of the total ration. Further increases in the level of gliricidia supplementation, under the conditions of this experiment, reduced the intake of elephant grass leading to substitution effects of the basal.

Quality of oral and parenteral chloroquine in Kampala.

Abstract: Malaria remains an important public health problem in Uganda. The mainstay of treatment is still chloroquine. However, recently there have been several reports of poor response to chloroquine treatment. We do not know whether the reported poor response is due to true resistance or poor quality of the drug in the market. This study was done to assess the quality of chloroquine dosage forms in Kampala. The study was cross-sectional; end-point designed to assess the amount of the active ingredient in the tablet and injection dosage forms of the drug. The quality assay was based on the BP, 1988 standard, using both visual and potentiometric analysis technique. The study demonstrated that there is a problem with the quality of chloroquine in the market. Upto 30% of the tablet samples and 33% of injection samples contained less than the stated amount of the active ingredient. This may be one of the reasons for the reported poor response of malaria to chloroquine treatment in Uganda. Given that routine laboratory testing of active ingredients in pharmaceuticals is not practised in Uganda, this study has demonstrated the necessity for establishment of a drug quality control laboratory in the country.

Fruit Finding by Mangabeys ( Lophocebus albigena ): Are Monitoring of Fig Trees and Use of Sympatric Frugivore Calls Possible Strategies?

Abstract: Frugivorous forest primates face a continual challenge to locate ripe fruit due to the poor visibility characterizing a heavily vegetated habitat and the spatial and temporal unpredictability of their fruit sources. We present two hypotheses regarding fruit finding in gray-cheeked mangabeys (Lophocebus albigena). The first hypothesis is that mangabeys monitor nonfruiting fig trees by visiting and checking them for fruit at a higher rate than control trees that do not produce preferred fruit. We test this hypothesis by comparing rates of visitation to focal fig trees and control trees. The second hypothesis is that mangabeys use sympatric frugivore loud calls to locate fruit sources. We test this hypothesis (1) observationally, by comparing the rates at which mangabeys visit calling sites of sympatric frugivores and matched control areas; and (2) experimentally, by following mangabey responses to playbacks of tape-recorded calls: the black-and-white-casqued hornbill (Bycanistes subcylindricus) long call, the great blue turaco (Corythaeola cristata) rattling kok, the adult male mangabey whoopgobble, and the chimpanzee (Pan troglodytes) pant hoot. We tested the hypotheses via data from a single group of mangabeys in the Kibale National Park, Uganda. There is no evidence that mangabeys monitor fig trees for the presence of fruit, but they may use the calls of hornbills to locate fruit. Statistical evidence that mangabeys use conspecific whoopgobbles and chimpanzee pant hoots in fruit finding is lacking, though anecdotal observations suggest this possibility. There is no evidence for use of turaco calls in fruit finding.

Science education in Uganda: progress and possibilities

Abstract: An extensive survey of 110 randomly selected secondary schools in Uganda provided information on teaching and facilities. Questionnaires completed by 214 teachers and 630 students on attitudes towards secondary education and science education provided insight into perceptions of the role in general and science education in particular. Equivalent questionnaires were also completed by samples of parents, employers, employees and early school leavers. While there was considerable consensus across groups on the general aims of secondary education, differences arose when considering science education. Results indicate a view towards science as problem solving by teachers, suggesting a greater understanding of science than in the past. Students see science as having a high memorization emphasis and less problem solving. It is suggested that this is due to lack of practical experiences and science teaching facilities, large classes of 40‐90 students, traditional examination syllabuses, and lack of equipment, cla...

Bioethics and local circumstances.

Abstract: The ethics of the design of clinical trials to prevent transmission of HIV-1 from mother to child in developing countries have been criticized.[*][1] However, a discussion of ethical principles in biomedical research that ignores the socioeconomic heterogeneity of society is not ethical and not worth holding. Policies regarding health management differ within and between industrialized and developing countries because of their different economic capabilities. Whereas it is established policy that all HIV-positive pregnant women in the United States and other developed countries are offered azidothymidine (AZT), this is not achievable in many developing countries because the costs of the drug and logistical support are prohibitive. For example, Uganda (with 156,600 pregnancies per year) spends $6 annually in health care per person. In the ACTG 076 trial of AZT's ability to prevent maternal transmission of HIV-frequently used as the “gold standard” against which other trials are measured-AZT treatment was started in a hospital setting between 14 and 34 weeks of gestation and continued (through delivery) until the newborn infant was 6 weeks of age. Yet in Uganda, fewer than 10% of all pregnant women have prenatal care for the first time during the first trimester, 30% during the second trimester, and 60% during the third trimester; only 40% deliver in a health facility.[†][2] So to conduct research in Uganda based on such a regimen would produce results applicable only in a research setting. The future of clinical trials in Africa could depend on two factors. First, sponsoring agencies might slow down or stop the trials because of the ongoing debate about how best to conduct them. This would leave Africa in a terrible position because resources are not available there to do the trials. For maternal transmission studies, the results of testing alternative treatment regimens could lower the cost of therapy dramatically, to a point where it would be feasible for the governments to subsidize treatment. Evaluation of HIV vaccines is essential for Africa because the resources required for highly active antiretroviral treatment (HAART) are not available and other preventive interventions have their own limitations.[‡][3] The second factor is the extent to which the people in developing countries will be influenced by the debate. Discussions that ignore the magnitude of the problem, gloss over the socioeconomic circumstances of poor nations, and apply previously developed ethical guidelines too literally may lead individuals to reduce their participation in future trials. So far, policy-makers and politicians have not interfered with ongoing trials because of the current debate. Following the atrocities committed by Nazi research physicians, ethical guidelines to protect research subjects were laid down in the Nuremberg Code, the Declaration of Helsinki, and the “International Ethical Guidelines for Biomedical Research Involving Human Subjects” (issued in 1982 and revised in 1993).[§][4] The 1993 guidelines were designed to be of use, particularly to developing countries, in defining national policies on the ethics of biomedical research, applying ethical standards in local circumstances, and establishing or redefining adequate mechanisms for ethical review of research involving humans. In their present form these guidelines will delay development of badly needed vaccines and treatment regimens. For example, they state that phase I drug studies and phase I and II vaccine studies should only be conducted in “developed communities of the country of the sponsor.” Likewise, the guidelines say that phase III vaccine trials and phase II and III drug trials should be conducted simultaneously in the host and sponsoring countries. Barry R. Bloom discusses other ethical issues in this issue. [|][5] Regional meetings are being convened in Africa, Asia, Latin America, North America, and Europe early in the year to address the obstacles posed by the guidelines in their current form. Resulting improvements are expected to make the guidelines more specific so that there will be no roadblocks in the way of conducting ethical clinical trials. [1]: #fn-1 [2]: #fn-2 [3]: #fn-3 [4]: #fn-4 [5]: #fn-5

Effect of refining and supplementation on the viscosity and energy density of weaning maize porridges

Abstract: The study was undertaken to establish the extent to which use of refined maize flour in weaning porridges affects the viscosity and the energy density of the resulting porridges. Maize porridges from both refined and whole flours were made using modified traditional methods and the viscosity of the porridges was measured using a rotational viscometer. Other factors that might influence the viscosity outcome of the porridges such as flour concentration, supplementation with energy-rich foods, cooking time, temperature at the time of measurement simulating feeding temperature and shear speed were included at three levels per factor (low, medium and high) in a Central Composite Design. Overall, refined flour porridges had significantly (P ≤ 0.0001) higher viscosity than whole flour porridges. Increasing concentration and cooking time significantiy (P ≤ 0.0001, P = 0.0003, respectively) increased the viscosity of the maize porridges while addition of groundnut, addition of cow's milk and increased shear speed...