Showing papers by "Makerere University published in 2002"

Diarrhoea and effects of different water sources, sanitation and hygiene behaviour in East Africa

Abstract: published studies on domestic water use and environmental health in East Africa, based on direct observations or other reliable research methods. The objective of this study was to carry out a repeat analysis of domestic water use and environmental health in East Africa based on DOW I. The study was conducted in the same sites as DOW I. Field assistants spent at least 1 day in each household observing and conducting semi-structured interviews. They measured the amount of water collected, recorded the amount of water used in the home, and noted household socio-demographic characteristics, prevalence of diarrhoea, state and use of latrines, sources of water and conditions of use. We surveyed 1015 households in 33 sites in Uganda, Tanzania and Kenya in 1997. From 1967 to 1997, the prevalence of diarrhoea, in the week preceding the survey, increased from 6% to 18% in Kenya and from 16% to 21% in Uganda; it declined slightly in Tanzania (11–8%). Determinants of diarrhoea morbidity included poor hygiene (unsafe disposal of faeces and wastewater), education level of household head, obtaining water from surface sources or wells and per capita water used for cleaning. Hygiene practices are an important complement to improved water and sanitation in reducing diarrhoea morbidity.

What proportion of episodes of gonorrhoea and chlamydia becomes symptomatic

Abstract: The effectiveness of syndromic treatment as an STD control strategy depends on the proportion of episodes which become symptomatic; few studies have measured this directly. We estimated these proportions for gonorrhoea (NG) and chlamydia (CT), synthesizing data on the point prevalence of self-reported discharge and dysuria among infected cases in rural Uganda, the durations of symptoms, incubation period and asymptomatic episodes, and the effect of treatment on symptom duration. Estimated proportions of episodes that become symptomatic were 45% for males with NG, 11% for males with CT, 14% for females with NG and 6% for females with CT. This was on average 1.5-fold higher than symptom prevalence at cross-section among infected cases in this population. Estimates were sensitive to assumptions on the relative durations of asymptomatic and symptomatic episodes, but were invariably inconsistent with previous direct estimates based on a US cohort study. These results show that the probability of recognizing symptoms in NG and CT episodes varies between settings. In populations with low treatment rates like Uganda, these probabilities can be very low. Here, health education should have priority in STD management programmes.

Citywide trauma experience in Kampala, Uganda: a call for intervention

Abstract: Objectives: To describe injuries and their emergency care at five city hospitals. Setting: Data were collected between January and December 1998 from casualty departments of the five largest hospitals of Kampala city, Uganda, with bed capacity ranging from 60 to 1200. Methods: Registry forms were completed on trauma patients. All patients with injuries were eligible. Outcome at two weeks was determined for admitted patients. Results: Of the 4359 injury patients, 73% were males. Their mean age was 24.2 years, range 0.1–89, and a 5–95 centile of 5–50 years. Patients with injuries were 7% of all patients seen. Traffic crashes caused 50% of injuries, and were the leading cause for patients ≥10 years. Fifty eight per cent of injuries occurred on the road, 29% at home, and 4% in a public building. Falls, assaults, and burns were the main causes in homes. Fourteen per cent of injuries were intentional. Injuries were severe in 24% as determined with the Kampala trauma score. One third of patients were admitted; two thirds arrived at the hospital within 30 minutes of injury, and 92% were attended within 20 minutes of arrival. Conclusions: Injuries in Kampala are an important public health problem, predominantly in young adult males, mostly due to traffic. The majority of injuries are unintentional. Hospital response is rapid, but the majority of injuries are minor. Without pre-hospital care, it is likely that patients with serious injuries die before they access care. Preventive measures and a pre-hospital emergency service are urgently needed.

The epidemiology of conjunctival squamous cell carcinoma in Uganda

Abstract: As part of a larger investigation of cancer in Uganda, we conducted a case–control study of conjunctival squamous cell carcinoma in adults presenting at hospitals in Kampala. Participants were interviewed about social and lifestyle factors and had blood tested for antibodies to HIV, KSHV and HPV-16, -18 and -45. The odds of each factor among 60 people with conjunctival cancer was compared to that among 1214 controls with other cancer sites or types, using odds ratios, estimated with unconditional logistic regression. Conjunctival cancer was associated with HIV infection (OR 10.1, 95% confidence intervals [CI] 5.2–19.4; P<0.001), and was less common in those with a higher personal income (OR 0.4, 95% CI 0.3–1.2; P<0.001). The risk of conjunctival cancer increased with increasing time spent in cultivation and therefore in direct sunlight (χ2 trend=3.9, P=0.05), but decreased with decreasing age at leaving home (χ2 trend=3.9, P=0.05), perhaps reflecting less exposure to sunlight consequent to working in towns, although both results were of borderline statistical significance. To reduce confounding, sexual and reproductive variables were examined among HIV seropositive individuals only. Cases were more likely than controls to report that they had given or received gifts for sex (OR 3.5, 95% CI 1.2–10.4; P=0.03), but this may have been a chance finding as no other sexual or reproductive variable was associated with conjunctival cancer, including the number of self-reported lifetime sexual partners (P=0.4). The seroprevalence of antibodies against HPV-18 and -45 was too low to make reliable conclusions. The presence of anti-HPV-16 antibodies was not significantly associated with squamous cell carcinoma of the conjunctiva (OR 1.5, 95% CI 0.5–4.3; P=0.5) and nor were anti-KSHV antibodies (OR 0.9, 95% CI 0.4–2.1; P=0.8). The 10-fold increased risk of conjunctival cancer in HIV infected individuals is similar to results from other studies. The role of other oncogenic viral infections is unclear. British Journal of Cancer (2002) 87, 301–308. doi:10.1038/sj.bjc.6600451 www.bjcancer.com © 2002 Cancer Research UK

Appropriate treatment of malaria? Use of antimalarial drugs for children's fevers in district medical units, drug shops and homes in eastern Uganda

Abstract: This study aimed to evaluate the quality of pharmaceutical care of malaria for children in eastern Uganda prescribed at government health units and drug shops and administered by caretakers at home; and to assess its appropriateness in relation to national treatment guidelines which recommend chloroquine over 3 days. The authors followed 463 children under 5 years whose caretakers attended two drug shops and two government health units to seek treatment for fever. The children were examined and the caretakers interviewed on the day of the day of enrollment in the study (day 0) and in their homes on days 3 and 7. Data was collected on drug use prior to attending the shop or health unit the treatment provided at these study sites and the administration of drugs at home over the following 3 days. Results showed that before attending the study sites 72% of children had already been given some biomedical drugs and 40% had received the recommended drug chloroquine. Health workers prescribed chloroquine for 94% of the children but only 34% of the recommended doses followed guidelines. Two-thirds of the children were prescribed an injection of chloroquine. By day 3 according to caretaker reports about 38% of the children had received chloroquine in compliance with the instructions given by the health workers and drug shop attendants. Only 28% of the children had received chloroquine at the optimal dose of 20-30 mg/kg recommended by national policy. Overall the methods were useful for examining adherence of both caretakers and health care providers to national guidelines and the extent to which caretakers were compliant with providers prescriptions. Chloroquine and antipyretics were the drugs of choice for fever in these areas of rural eastern Uganda. But children did not receive the recommended dosage of chloroquine because of lack of compliance on the parts of providers as well as users of health care. (authors)

Fighting and mating between groups in a cooperatively breeding mammal, the banded mongoose

Abstract: Many cooperatively breeding animals actively defend a territory containing resources such as food and shelter, which are essential for reproduction. Some observations, however, indicate that conflicts between groups are often triggered by the attempts of males or females, or both, to gain extra-group copulations. We studied interactions between 12 groups of banded mongooses (Mungos mungo) in Uganda to test whether the frequency of inter-group encounters was linked to the reproductive status of females, and conducted an experiment to examine the responses of individuals to mongooses from other groups. The rate at which focal groups fought with other groups was higher when its females were in estrous, suggesting that many fights take place over access to mates. Both males and estrous females were instrumental in instigating encounters with rival groups, and extra-group copulation in the midst of a fight was observed on three occasions. We experimentally simulated encounters with foreign individuals by presenting each of six groups with cages containing a male and a female from a rival group. Subordinate males were the first to investigate these ‘intruders’, spent more time around the intruders' cages, and were more aggressive to the intruders than either dominant males or females. Subordinate males directed more attention and aggression towards the male intruder than the female intruder. We suggest that male banded mongooses actively seek extra-group copulations in pursuit of paternity, while females may actively seek extra-group copulations as a way of reducing inbreeding depression.

Identification of the Causative Organism of Tuberculous Lymphadenitis in Ethiopia by PCR

Abstract: Tuberculous lymphadenitis (TBLN) is a common form of extrapulmonary tuberculosis with multiple differential diagnoses. Demonstration of the etiologic agent by smear microscopy or culture of fine needle aspirate (FNA) specimens is often unsuccessful. FNA specimens from 40 patients presenting at a rural health center in South Ethiopia and diagnosed as positive for TBLN on the basis of clinical and cytological criteria were analyzed for mycobacterial DNA by PCR. Thirty (75%) had cervical lymphadenitis and 11 (27.5%) were seropositive for human immunodeficiency virus (HIV). Three primer sets were initially used to identify the causative agent at the genus (antigen 85 complex), complex (IS6110 insertion sequence), and species (pncA gene and allelic variation) levels. Among the forty TBLN cases, 35 (87.5%) were positive by PCR at the genus and complex levels. Based on PCR for detection of allelic variation at position 169, 24 (68.6%) of the 35 were positive for Mycobacterium tuberculosis and 6 (17.1%) were positive for M. bovis. These six were positive in additional PCR assays using the JB21-JB22 primer set, which is highly specific for M. bovis. Five (14.1%) showed amplification for both M. tuberculosis and M. bovis with the allele-specific primer set. Cooccurrence of pyrazinamide (PZA)-sensitive and -resistant M. tuberculosis in those five cases was indicated, since all were negative in assays with the JB21-JB22 primer set. This feature was seen in 3 of 11 HIV-positive and 2 of 29 HIV-negative individuals (P < 0.001). Conclusion: among 35 PCR-positive cases of TBLN from southern Ethiopia, 29 (82.9%) were caused by M. tuberculosis and six (17.1%) were caused by M. bovis.

The Rakai Project counselling programme experience.

Abstract: During the initial survey (April 1999-January 2000) of an ongoing Community HIV Epidemiological Research (CHER) study, adults aged 15-49 years in 56 study communities were enrolled into the study Knowledge, Attitude, Behaviour, Practice questionnaires were administered and blood was obtained from 776% HIV testing was performed using two different enzyme immunosorbent assays with Western blot confirmation of discordant results and first time positives All those who gave blood had free and unlimited access to voluntary counselling and testing (VCT), and were free to participate as individuals or couples HIV results were provided in people's homes by trained and certified project resident counsellors Ninety per cent of those who were bled requested their HIV results, while 646% of those who requested their HIV results received them The proportion of people receiving HIV results has almost doubled in the last 6 years (1994-2000) from about 35% in 1994/1995 to 65% in 1999/2000 These data indicate high proportions of acceptance and receipt of VCT in this rural population-based cohort, suggesting that home delivery of VCT could offer a unique opportunity for people in the rural areas to access counselling and testing services, given adequate resources

Enterocytozoon bieneusi among children with diarrhea attending Mulago Hospital in Uganda.

Abstract: The prevalence of Enterocytozoon bieneusi in the general population is unknown. Using genetic tools, we investigated its prevalence and contribution to diarrhea and malnutrition in hospitalized children in Uganda. A cross-sectional, case-control study involving diarrheic children who were matched for age and sex (3:1) with control children. Measurements included anthropometry and clinical assessment. A total of 17.4% of 1,779 children with diarrhea were infected with E. bieneusi compared with 16.8% of 667 control children (CHI2 = 0.137, P = 0.712). Prevalence was highest during the rainy seasons. There was no significant relationship between infection with E. bieneusi and stunting, being underweight, wasting, or acute diarrhea. However, children who were E. bieneusi-positive by a polymerase chain reaction (PCR) had diarrhea for a longer period (15.15 versus 9.67 days; F = 12.02; P = 0.001) compared with children who were either uninfected or were E. bieneusi-positive by a nested PCR. We conclude that E. bieneusi is widespread among children 3-36 months of age in Uganda, and that in a cross-sectional study, there was no clear association of E. bieneusi with poor nutrition or diarrhea. Since E. bieneusi is closely linked with persistent diarrhea and wasting in adults who are positive for human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), the outcome of follow-up studies involving children who are HIV/AIDS-positive and severely malnourished children may be entirely different and warrants further study.

An Overview of Chronic Poverty and Development Policy in Uganda

Abstract: The paper highlights Uganda’s main antipoverty programs and uses consumption expenditure data of panel households to characterize chronic poverty by tracking households’ poverty statuses over time. Although the majority of households moved into and out of poverty during the 1990s, all the panel households that experienced persistent poverty for at least five years were engaged in agricultural self-employment as the main economic activity. This evidence underscores the importance of off-farm opportunities in poverty reduction. The results showing that households which are far below the poverty line (for example, the poorest 20%) are the most likely to experience extended duration of poverty suggest that the chronically poor may not benefit much from Uganda’s economic growth programs, which primarily aim at creating an enabling environment for economic agents to exploit using their initial endowment of capabilities.

Among 46 near full length HIV type 1 genome sequences from Rakai District, Uganda, subtype D and AD recombinants predominate.

Abstract: The impact of HIV-1 genetic diversity on candidate vaccines is uncertain. To minimize genetic diversity in the evaluation of HIV-1 vaccines, vaccine products must be matched to the predominant subtype in a vaccine cohort. To that end, full genome sequencing was used to detect and characterize HIV-1 subtypes and recombinant strains from individuals in Rakai District, Uganda. DNA extracted from peripheral blood mononuclear cells (PMBC) was PCR amplified using primers in the long terminal repeats (LTRs) to generate nearly full length genomes. Amplicons were directly sequenced with dye terminators and automated sequencers. Sequences were phylogenetically analyzed and recombinants were detected and mapped with distance scan and bootscan. Among 46 sequences, 54% were subtype D, 15% were subtype A, and 30% were recombinant. All recombinants were individually unique, and most combined subtypes A and D. Subtype D comprised more than 70% of all the HIV-1 genomes in Rakai when both pure subtypes and recombinants were considered. Candidate vaccines based on HIV-1 subtype D would be appropriate for evaluation in Rakai District, Uganda.

Mycobacterium africanum Subtype II Is Associated with Two Distinct Genotypes and Is a Major Cause of Human Tuberculosis in Kampala, Uganda

Abstract: The population structure of 234 Mycobacterium tuberculosis complex strains obtained during 1995 and 1997 from tuberculosis patients living in Kampala, Uganda (East Africa), was analyzed by routine laboratory procedures, spoligotyping, and IS6110 restriction fragment length polymorphism (RFLP) typing. According to biochemical test results, 157 isolates (67%) were classified as M. africanum subtype II (resistant to thiophen-2-carboxylic acid hydrazide), 76 isolates (32%) were classified as M. tuberculosis, and 1 isolate was classified as classical M. bovis. Spoligotyping did not lead to clear differentiation of M. tuberculosis and M. africanum, but all M. africanum subtype II isolates lacked spacers 33 to 36, differentiating them from M. africanum subtype I. Moreover, spoligotyping was not sufficient for differentiation of isolates on the strain level, since 193 (82%) were grouped into clusters. In contrast, in the IS6110-based dendrogram, M. africanum strains were clustered into two closely related strain families (Uganda I and II) and clearly separated from the M. tuberculosis isolates. A further characteristic of both M. africanum subtype II families was the absence of spoligotype spacer 40. All strains of family I also lacked spacer 43. The clustering rate obtained by the combination of spoligotyping and RFLP IS6110 analysis was similar for M. africanum and M. tuberculosis, as 46% and 49% of the respective isolates were grouped into clusters. The results presented demonstrate that M. africanum subtype II isolates from Kampala, Uganda, belong to two closely related genotypes, which may represent unique phylogenetic branches within the M. tuberculosis complex. We conclude that M. africanum subtype II is the main cause of human tuberculosis in Kampala, Uganda.

Prevalence of aggressive periodontitis in school attendees in Uganda

Abstract: Aim: The prevalence and severity of early onset periodontitis (EOP) among students attending secondary schools in two regions of Uganda was studied. Material and methods: 690 students (393 males and 297 females) aged 12–25 years (mean 17 years), representing a range of tribal groups, were recruited from six schools in the peri-urban Central and rural Western regions of Uganda. The study subjects were clinically examined in field conditions by a single calibrated examiner to measure gingival recession and probing depth at six sites per tooth, with subsequent calculation of clinical periodontal attachment level for each site. Subjects exhibiting ≥ 4 mm of clinical periodontal attachment loss at approximal surfaces of one or more teeth were classified with EOP. A structured written questionnaire obtained demographic characteristics of the study subjects. Results: 199 (28.8%) study subjects showed clinical features of EOP, of which 16 (2.3%) subjects exhibited generalized EOP, 29 (4.2%) localized EOP, and 154 (22.3%) incidental EOP. The percentage of EOP-affected males was significantly higher than females (33.8% vs. 22.2%, P < 0.001). EOP prevalence tended to increase with increasing age, but no association was found between EOP prevalence and socioeconomic status or residency in urban vs. rural areas of Uganda. Molars and mandibular incisors generally demonstrated the highest occurrence of ≥ 4 mm attachment loss. Clinical periodontal attachment loss of ≥ 5 mm was mainly seen at first molars and incisors, suggesting that these two tooth types are first affected with attachment loss. Approximal tooth surfaces showed greater probing depth and attachment loss than buccal and lingual surfaces. Gingival recession was most prevalent at mandibular anterior teeth, whereas gingival margin coronal to CEJ was most frequently observed at second molars and maxillary incisors. Conclusion: A relatively high prevalence of EOP (28.8%) was found in young Ugandan school attendees, with 6.5% of these showing severe disease. EOP in Uganda was significantly more prevalent in males than females, and most frequently characterized by approximal involvement of molars and mandibular incisors. Etiologic and predisposing factors associated with the high occurrence of EOP in Uganda, as well as therapeutic and preventive measures of the disease in this population, remain to be delineated.

Effect of intercropping cereal crops with forage legumes and source of nutrients on cereal grain yield and fodder dry matter yields

Abstract: (Received 21 April, 2001; accepted 2 February, 2002) Abstract The study investigated the effect of intercropping cereals (maize, sorghum and wheat) with forage legumes (lablab and clover), planting methods and manure application on cereal grain and fodder dry matter yield and fodder nutritive value. Data collected over a period of three years, indicated that intercropping significantly (P 0.05) by planting method. However, intercropping forage legumes with cereals generally resulted in fodder with higher fodder CP concentration, lower NDF and higher dry matter degradability than fodder from sole cereals. Manure application into cereal + forage legume cropping systems significantly (P Key Words: Clover, fertiliser, lablab, maize, manure, urea Resume Les effets des cultures intercalees des cereales (mais, sorgho et ble) avec fourrages (lablab et trefle), methodes de planter et l'application des fumiers sur les grains des cereales et les rendements en fourrages secs et leurs valeurs nutritives ont ete etudie. Les donnees recoltees pendant trois ans ont montre que les rendements en fourrages ont significativement augmente (27%) mais legerement diminue les rendements en grains (21%) par rapport aux cereales en monoculture. La disposition en lignes a produit un rendement eleve en fourrages secs (5%) et en grains des cereales que les cereales plantes aux hazard. La valeur nutritive (CP, NDF et degradabilite de la matiere seches) des fourrages n'a pas ete affectee (P>0.05) par la methode de planter. Cependant, la culture des fourrages et les cereales intercales a genere des fourrages a avec concentrations en CP et une degradabilite de la matiere seches elevees et de faibles NDF. L'application des fumiers dans les cereales + les systemes culturales des fourrages a augmentee significativement les rendemenrs en grains et matiere seches des fourrages (2,9-3,6 t ha –1 et 8,2 – 9,3 t ha–1 ; respectivement) que les fertilisants inorganiques (3,2 et 8,8 t ha–1). Ces rendements etaient significativement (P Mots Cles: Trefle, fetilisant, mais, fumier, uree (Af Crop Sci J 2002 Vol 10 No 1 pp81-98)

Increasing antimalarial drug resistance in Uganda and revision of the national drug policy.

Abstract: Chloroquine (CQ) resistance was first documented in Uganda in 1988. Subsequent surveillance of antimalarial drug resistance, conducted by the Ugandan Ministry of Health and several research organizations, suggests that resistance to CQ is now widespread, reaching critical levels in many areas of the country. In June 2000, the Ministry of Health held a National Consensus Meeting to evaluate the available drug efficacy data and review the national antimalarial drug policy. After extensive debate, the combination of CQ + sulfadoxine-pyrimethamine (SP) was chosen to replace CQ as the first-line treatment of uncomplicated malaria as an interim policy. This review evaluates the in vivo drug efficacy studies conducted in Uganda since 1988 and issues confronted in revision of the drug policy. The Ugandan experience illustrates the challenges faced by sub-Saharan African countries confronted with rising CQ resistance but limited data on potential alternative options. The choice of CQ + SP as a provisional policy in the absence of prerequisite efficacy, safety and cost-effectiveness data reflects the urgency of the malaria treatment problem, and growing pressure to adopt combination therapies. Surveillance of CQ + SP treatment efficacy, collection of additional data on alternative regimens and active consensus building among key partners in the malaria community will be necessary to develop a rational long-term antimalarial treatment policy in Uganda.

Population structure of the African savannah elephant inferred from mitochondrial control region sequences and nuclear microsatellite loci.

Abstract: Two hundred and thirty-six mitochondrial DNA nucleotide sequences were used in combination with polymorphism at four nuclear microsatellite loci to assess the amount and distribution of genetic variation within and between African savannah elephants. They were sampled from 11 localities in eastern, western and southern Africa. In the total sample, 43 haplotypes were identified and an overall nucleotide diversity of 2.0% was observed. High levels of polymorphism were also observed at the microsatellite loci both at the level of number of alleles and gene diversity. Nine to 14 alleles per locus across populations and 44 alleles in the total sample were found. The gene diversity ranged from 0.51 to 0.72 in the localities studied. An analysis of molecular variance showed significant genetic differentiation between populations within regions and also between regions. The extent of subdivision between populations at the mtDNA control region was approximately twice as high as shown by the microsatellite loci (mtDNA FST = 0.59; microsatellite RST = 0.31). We discuss our results in the light of Pleistocene refugia and attribute the observed pattern to population divergence in allopatry accompanied by a recent population admixture following a recent population expansion.

Iron Deficiency Anemia Is Highly Prevalent among Human Immunodeficiency Virus–Infected and Uninfected Infants in Uganda

Abstract: Although anemia is a common finding among human immunodeficiency (HIV)-infected infants in sub-Saharan Africa the factors contributing to the pathogenesis of anemia have not been well characterized. We sought to characterize the relative contribution of iron deficiency and chronic disease to the anemia among infants. Hemoglobin ferritin erythropoietin tumor necrosis factor-a (TNF-a) neopterin CD4+ lymphocyte count and plasma HIV load were measured in 165 HIV-infected and 39 uninfected 9-mo-old infants seen in an outpatient pediatric clinic in Kampala Uganda. Among HIV-infected and uninfected infants the prevalence of anemia (hemoglobin < 110 g/L) was 90.9 and 76.9% respectively (P = 0.015) and the prevalence of iron deficiency anemia (hemoglobin < 110 g/L and ferritin < 12 µg/L) was 44.3 and 45.4% respectively (P = 0.92). The relatively higher prevalence of anemia among HIV-infected infants was attributed to the anemia of chronic disease. Among infants with and without iron deficiency the fitted regression line was log10 plasma erythropoietin = 2.86 -0.016·hemoglobin and log10 plasma erythropoietin = 4.11 -0.028·hemoglobin respectively with a difference in the slope of the regression lines between log10 erythropoietin and hemoglobin among infants with and without iron deficiency (P = 0.049). Infants in Uganda have an extremely high prevalence of anemia and nearly half of the anemia is due to iron deficiency. The erythropoietin response to anemia appears to be upregulated among infants with iron deficiency. (authors)

A single genotype of Encephalitozoon intestinalis infects free-ranging gorillas and people sharing their habitats in Uganda.

Abstract: Microsporidian spores have been detected by Chromotrope 2R and calcofluor stains in fecal samples of three free-ranging human-habituated mountain gorillas in Uganda and in two people who share gorilla habitats. All spore isolates have been identified by PCR with species-specific primers and fluorescent in situ hybridization with a species-specific oligonucleotide probe to be Encephalitozoon intestinalis. Sequencing analyses of the full length SSUrRNA amplified from all spore isolates were identical with Enc. intestinalis SSUrRNA GenBank SIU09929. Sequences generated from a fragment containing the internal transcribed spacer of these isolates were identical to GenBank sequence Y11611, i.e., Enc. intestinalis of anthroponotic origin. A single pathogen genotype in two genetically distant but geographically united host groups indicates anthropozoonotic transmission of Enc. intestinalis. It is highly unlikely that these two identical Enc. intestinalis genotypes were acquired independently by gorillas and people; it is much more probable that one group initiated infection of the other.

Cryptosporidiosis in people sharing habitats with free-ranging mountain gorillas (Gorilla gorilla beringei), Uganda

Abstract: Cryptosporidiosis, a zoonotic diarrheal disease, significantly contributes to the mortality of people with impaired immune systems worldwide. Infections with an animal-adapted genotype (Genotype 2) of Cryptosporidium parvum were found in a human population in Uganda that shares habitats with free-ranging gorillas, from which the same genotype of C. parvum had been recovered previously. A high prevalence of disease was found in park staff members (21%) who frequently contact gorillas versus 3% disease prevalence in the local community. This indicates a zoonotic transmission cycle of this pathogen against which no effective prophylaxis or therapy exists. The results of the study questionnaire demonstrated a high percentage of people not undertaking appropriate precautions to prevent fecal-oral transmission of C. parvum in the Bwindi Impenetrable National Park, Uganda. This human population will benefit from stronger compliance with park regulations regarding disposal of their fecal waste within the park boundaries.

A survey of the prevalence of refractive errors among children in lower primary schools in Kampala district.

Abstract: Background: Refractive errors are a known cause of visual impairment and may cause blindness worldwide. In children, refractive errors may prevent those afflicted from progressing with their studies. In Uganda, like in many developing countries, there is no established vision-screening programme for children on commencement of school, such that those with early onset of such errors will have many years of poor vision. Over all, there is limited information on refractive errors among children in Africa. Objective: To determine the prevalence of refractive errors among school children attending lower primary in Kampala district; the frequency of the various types of refractive errors, and their relationship to sexuality and ethnicity. Design: A cross-sectional descriptive study. Setting: Kampala district., Uganda Patients: A total of 623 children aged between 6 and 9 years had a visual acuity testing done at school using the same protocol; of these 301 (48.3%) were boys and 322 (51.7%) girls. Results: Seventy-three children had a significant refractive error of ±0.50 or worse in one or both eyes, giving a prevalence of 11.6% and the commonest single refractive error was astigmatism which accounted for 52% of all errors. This was followed by hypermetropia, and myopia was the least common. Conclusion: Significant refractive errors occur among primary school children aged 6 to 9 years at a prevalence of approximately 12%. Therefore, there is a need to have regular and simple vision testing in primary school children at least at the commencement of school so as to defect those who may suffer from these disabilities. African Health Sciences 2002;2(2):69-72

Human immunodeficiency virus type 1 (HIV-1) quasispecies at the sites of Mycobacterium tuberculosis infection contribute to systemic HIV-1 heterogeneity.

Abstract: We have recently reported an increased heterogeneity in the human immunodeficiency virus type 1 (HIV-1) envelope gene (env) in HIV-1-infected patients with pulmonary tuberculosis (TB) compared to patients with HIV-1 alone. This increase may be a result of dissemination of lung-derived HIV-1 isolates from sites of Mycobacterium tuberculosis infection and/or the systemic activation of the immune system in response to TB. To distinguish between these two mechanisms, blood and pleural fluid samples were obtained from HIV-1-infected patients with active pleural TB in Kampala, Uganda (CD4 cell counts of 34 to 705 cells/microl, HIV-1 plasma loads of 2,400 to 280,000 RNA copies/ml, and HIV-1 pleural loads of 7,600 to 4,500,000 RNA copies/ml). The C2-C3 coding region of HIV-1 env was PCR amplified from lysed peripheral blood mononuclear cells and pleural fluid mononuclear cells and reverse transcriptase-PCR amplified from plasma and pleural fluid HIV-1 virions of eight HIV-1 patients with pleural TB. Phylogenetic and phenetic analyses revealed a compartmentalization of HIV-1 quasispecies between blood and pleural space in four of eight patients, with migration events between the compartments. There was a trend for a greater genetic heterogeneity in the pleural space, which may be the result of an M. tuberculosis-mediated increase in HIV-1 replication and/or selection pressure at the site of infection. Collectively, these findings suggest that HIV-1 quasispecies in the M. tuberculosis-infected pleural space may leak into the systemic circulation and lead to increased systemic HIV-1 heterogeneity during TB.

HIV dynamics and behaviour change as determinants of the impact of sexually transmitted disease treatment on HIV transmission in the context of the Rakai trial.

Abstract: Objective: To assess how the impact of sexually transmitted disease (STD) treatment on HIV incidence varies between stages of the HIV epidemic. Methods: We simulated the spread of curable STD, herpes simplex virus type 2 and HIV in the dynamic transmission model STDSIM. Parameters were quantified to represent a severe HIV epidemic as in Rakai, Uganda, using demographic, behavioural and epidemiological data from a recent STD treatment trial. Results: The model fitted the HIV epidemic in Rakai if we assumed a considerable behavioural risk reduction, starting at the end of the Ugandan civil war in 1986. An improvement in STD treatment reduced HIV incidence in this population by 35% over 2 years if implemented in 1981, but only by 11 and 8% in 1988 or 1998. This trend resulted partly from the hypothesized behaviour change, which markedly reduced the prevalences of bacterial STD. In a simulated epidemic without behavioural change, the corresponding treatment impacts in 1988 and 1998 would be 19 and 15%. Enhanced herpetic ulceration in immunocompromised HIV patients contributed little to the reduced impact of treatment of bacterial STD over time. Conclusion: In HIV epidemics beyond the first decade, the impact of STD treatment programmes on HIV transmission may depend more on behavioural risk reduction than on the stage of the epidemic. Preceding behavioural change associated with restored civil stability may have contributed to the lack of impact of STD treatment on HIV in the Rakai trial. In advanced epidemics with less behaviour change, STD treatment may still be important for HIV prevention.

The perspective of sweetpotato chlorotic stunt virus in sweetpotato production in Africa: A review

Abstract: Sweetpotato chlorotic stunt virus (SPCSV) (Crinivirus: Closteroviridae) occurs in the main tropical regions of the World and is probably the most damaging pathogen of sweetpotato (Ipomoea batatas). However, until recently little research had been done on it. The methods of identification were inadequate and this led to synonymy. The virus is transmitted by the whitefly species, Bemisia tabaci and Trialeurodes abutilonea, in a semi-persistent fashion. At least two serotypes occur, one, first described from West Africa (SPCSVWA), and the other first described from East Africa (SPCSVEA). Both serotypes have also been found in the Americas. Nucleotide sequencing has facilitated the process of distinguishing strains. The SPCSV may have originated along with sweetpotato in the Americas, but is perhaps more likely to have been a ‘new encounter' for sweetpotato when it was introduced to Africa and elsewhere in the ‘Old World'. It infects few plant species other than Ipomoea spp. The virions comprise long flexuous particles and the genome is RNA and bipartite. Geographically, isolated strains of SPCSV have been distinguished using serological- and nucleic acid-based methods. The virus synergises Sweetpotato feathery mottle virus (SPFMV) (Potyvirus: Potyviridae), leading to increased titres of this virus and the development of the severe disease sweetpotato virus disease (SPVD) in dually infected sweetpotato plants. Plants affected by SPVD following artificial or natural infection with SPCSV plus SPFMV have generally yielded c.60 – 90% less than uninfected or unaffected controls in field trials; plants infected with the SPCSV alone generally yielded c.30 – 80% less. However, in crops, compensatory growth by unaffected neighbouring sweetpotato plants probably results in direct effects on overall crop yields being small, and the major effect of SPCSV in constraining the yields of sweetpotato is perhaps through preventing the cultivation of high yielding but SPVD-susceptible sweetpotato cultivars. Breading resistant high-yielding varieties has been the main means of avoiding the deleterious effects of SPVD. Although sweetpotato cutivars which have field resistance to SPCSV have been identified, no gene conferring immunity to SPCSV has been identified within sweetpotato or its close relatives. Cultivars non-indigenous to Africa seem particularly susceptible. Extreme resistance has been identified in certain wild Ipomoea spp. Recent epidemiological studies indicated that most spread of SPCSV is short distance, leading to interest in the use of phytosanitation measures to grow high-yielding but somewhat SPVD-susceptible cultivars. This paper comprises a review of research work done on SPCSV world wide dating from 1939 to-date. Key Words: Africa, Bemisia tabaci, Ipomoea batatas, Sweetpotato feathery mottle virus Resume Le virus d'arret de croissance de la patate douce chlorotique (SPCSV) (Crinivirus: Closteroviridae) aparait dans les principales regions tropicales du monde et est probablement le pathogene le plus prejudiciable de la patate douce (Ipomoea batatas). Cependant, jusque recemment, peu de recherches avaient ete faites sur lui. Les methods d'identification etaient inadequates et ceci conduit a la synonymie. Le virus est transmis par les especes de mouche blanche, Bemisia tabaci et Trialeurodes abutilonea, dans un mode semi persistant. Au moins deux serotypes ont lieu, un, premierement decrit en Afrique de l'ouest (SPCSVWA) et l'autre en Afrique de l'est (SPCSVEA). Les deux serotypes ont aussi ete trouves en Amerique. La nucleotide mise en sequence a aussi distingue les souches. Le SPCSV peut avoir tire son origine avec la patate douce en Amerique, mais est peut etre plus vraisemblablement un nouveau recontre pour la patate douce quad il etait introduit en Afrique et ailleurs dans le vieux monde. Il infecte peu d'especes de plantes autre que l'Ipomoea spp. Les virions comprennent des longues particules de flexuous et le genome est le RNA et le bipartite. Geographiquement, les souches isolees de SPCSV ont ete distinguees en utilisant les methods basees sur l'acide serologique et nucleique. Les virus synerge, le virus plumeux de taches de patate douce (SPFMV) (Potyvirus: Potiviridae) menant a des titres croissant de ce virus et le developpement de la severe maladie de virus de la patate douce (SPVD) en plantes de patate douce doublement infectees. Les plantes infectees par SPVD artificiellement ou naturellement avec SPCSV en plus du SPFMV ont generalement produit 60-90% moins que celles non infectees ou non affectees en champ d'essais, Les plants infectees avec le SPCSV seul, generalement ont produit 30-80% moins. Cependant, en plantes, la croissance compensatoire par les plantes de patate douce voisines non affectees resultent dans les effets directs sur les rendements totaux des plantes etant moindres , et l'effet majeur de SPCSV en contraignant les rendements de patate douce est peut etre a travers la prevention de cultures de haut rendement mais le SPVD predispose la patate douce aux cultivars. La production des varieties resistantes de rendement eleve a ete le moyen principal d'eviter les effets nuisibles de SPVD. Bien que les cultivars de patate douce qui ont un champ de resistance au SPCSV ont ete identifies, aucun gene conferrant l'immunite au SPCSV a ete identifie dans les patates douces our leurs proches. Les cultivars non indigenes a l'Afrique semblent particulierement predisposes. Une extreme resistance a ete identifiee dans certains Ipomoea spp. sauvages. Des recentes etudes epidemiologiques indiquent que le plus repandu de SPCSV est a courte distance, menant a l'interet dans l'usage des measures phytosanitaires pour planter des varieties a rendement eleve et quelque peu predispose au SPVD. Cet article comprend une revue de travaux de recherche fait sur le SPCSV dans le monde entier de 1939 a nos jours. Mots Cles: Afrique, Bemisia tabaci, Ipomoea batatas, Virus plumeux de tache de patate douce (Af Crop Sci J 2002 Vol 10 No 4 pp281-310)

Exemptions and waivers from cost sharing: ineffective safety nets in decentralized districts in Uganda.

Abstract: The introduction of user-payment for health services is frequently followed by concern about the impact on equity of access for poor people. Decentralizing governments often try to remedy the created inequities by putting in place safety nets in the form of exemptions and waivers in the user-fee systems. However, where user payments merely operate as local government strategies for health financing, without national policy they are likely to be self-defeating, as local governments are frequently more interested in raising revenue to meet recurrent costs of devolved services than in promoting equity. Thus guidelines put in place by the central government to operationalize safety nets are seen by local governments as being contradictory to this goal, and are thus ignored or altered to suit the district revenue aims. This study was carried out to investigate the context and the constraints in implementing exemption schemes. Data were collected in two selected administrative districts of Uganda (Mbarara and Mukono). Qualitative approaches to data collection were adopted, namely focus group discussions and key informant interviews with policy-makers, health administrators, service providers and community members. These methods were combined with document review. We found little evidence of safety-net guidelines initiated by decentralized/local governments, since district local governments had little motivation to extend exemptions, waivers or credits. The conclusion is that safety nets such as waivers and exemptions will only be effective if they are backed by a national health financing policy, they reconcile the often competing demands of local government revenue needs, and are strictly enforced and supervised by both the local and central governments. The implications of the findings for remedying the tension between the needs for cost recovery and for attainment of equity goals through exemption policies for the poor and indigent are discussed.

First trial of the HIV-1 vaccine in Africa: Ugandan experience

Abstract: Problems in setting up the first trial of an HIV-1 vaccine in Uganda are described here by Mugerwa and colleagues. The authors explain how they solved these problems and give suggestions to help researchers who are starting future trials of HIV vaccines Trials of the HIV-1 vaccine have been conducted in Europe, North America, Brazil, China, and Thailand.1 The first trial of a candidate vaccine in Africa was recently completed in Uganda. It involved a randomised, placebo controlled trial of a vaccine in healthy volunteers at low risk of HIV infection. 2 3 The vaccine, called “ALVAC-HIV,” uses a live recombinant canarypox vector to express envelope and core genes of HIV-1. Many commentators predicted that it would be difficult to conduct trials of HIV vaccines in developing countries because of scientific, sociobehavioural, ethical, and logistical barriers.4–8 Before we started the trial in Uganda, we gathered data to help us overcome these potential barriers. We collected epidemiological9 and sociobehavioural10 data about people who had participated in studies that looked at preparing for trials of the HIV vaccine. These data showed the prevalence and incidence of HIV, behaviours placing people at risk of becoming infected with HIV, and the social acceptability of a vaccine against HIV.9–11 The people received detailed education and counselling about infection with HIV and about HIV vaccines, and we recruited some for our trial.11 We organised three open workshops at the HIV candidate vaccine trial workshop in Kampala in 1996 to gain consensus from scientists, policy makers, community representatives, and the media about how to undertake research into HIV vaccines. Despite these initiatives to solve problems before the trial began, we still encountered many barriers. In this article, we discuss these barriers …