Showing papers by "Makerere University published in 2006"

Global Phylogeny of Mycobacterium tuberculosis Based on Single Nucleotide Polymorphism (SNP) Analysis: Insights into Tuberculosis Evolution, Phylogenetic Accuracy of Other DNA Fingerprinting Systems, and Recommendations for a Minimal Standard SNP Set

Abstract: We analyzed a global collection of Mycobacterium tuberculosis strains using 212 single nucleotide polymorphism (SNP) markers. SNP nucleotide diversity was high (average across all SNPs, 0.19), and 96% of the SNP locus pairs were in complete linkage disequilibrium. Cluster analyses identified six deeply branching, phylogenetically distinct SNP cluster groups (SCGs) and five subgroups. The SCGs were strongly associated with the geographical origin of the M. tuberculosis samples and the birthplace of the human hosts. The most ancestral cluster (SCG-1) predominated in patients from the Indian subcontinent, while SCG-1 and another ancestral cluster (SCG-2) predominated in patients from East Asia, suggesting that M. tuberculosis first arose in the Indian subcontinent and spread worldwide through East Asia. Restricted SCG diversity and the prevalence of less ancestral SCGs in indigenous populations in Uganda and Mexico suggested a more recent introduction of M. tuberculosis into these regions. The East African Indian and Beijing spoligotypes were concordant with SCG-1 and SCG-2, respectively; X and Central Asian spoligotypes were also associated with one SCG or subgroup combination. Other clades had less consistent associations with SCGs. Mycobacterial interspersed repetitive unit (MIRU) analysis provided less robust phylogenetic information, and only 6 of the 12 MIRU microsatellite loci were highly differentiated between SCGs as measured by GST. Finally, an algorithm was devised to identify two minimal sets of either 45 or 6 SNPs that could be used in future investigations to enable global collaborations for studies on evolution, strain differentiation, and biological differences of M. tuberculosis.

Assessing country-level efforts to link research to action

Abstract: We developed a framework for assessing country-level efforts to link research to action. The framework has four elements. The first element assesses the general climate (how those who fund research, universities, researchers and users of research support or place value on efforts to link research to action). The second element addresses the production of research (how priority setting ensures that users' needs are identified and how scoping reviews, systematic reviews and single studies are undertaken to address these needs). The third element addresses the mix of four clusters of activities used to link research to action. These include push efforts (how strategies are used to support action based on the messages arising from research), efforts to facilitate "user pull" (how "one-stop shopping" is provided for optimally packaged high-quality reviews either alone or as part of a national electronic library for health, how these reviews are profiled during "teachable moments" such as intense media coverage, and how rapid-response units meet users' needs for the best research), "user pull" efforts undertaken by those who use research (how users assess their capacity to use research and how structures and processes are changed to support the use of research) and exchange efforts (how meaningful partnerships between researchers and users help them to jointly ask and answer relevant questions). The fourth element addresses approaches to evaluation (how support is provided for rigorous evaluations of efforts to link research to action).

Spectrum of cancers among HIV-infected persons in Africa: The Uganda AIDS-Cancer Registry Match Study

Abstract: Although more than 25 million people in sub-Saharan Africa have human immunodeficiency virus (HIV) infection, little is known regarding their cancer risk. We investigated cancer risk among persons with HIV/AIDS in Uganda using record-linkage. We linked records of 12,607 HIV-infected persons attending The AIDS Support Organization (TASO) in Kyadondo County from October 1988 through December 2002 to the Kampala Cancer Registry. We calculated standardized incidence ratios (SIRs) to identify increased cancer risks in the early (4-27 months after TASO registration), late (28-60 months), or combined (4-60 months) incidence periods. We identified 378 cancers (181 prevalent, 197 incident) among TASO participants. Of incident cancers, 137 (70%) were AIDS-defining cancers. Risk was increased in the early-incident period, compared to the general population, for the AIDS-defining cancers: Kaposi sarcoma (SIR 6.4, 95%CI 4.8-8.4), non-Hodgkin lymphoma (6.7, 1.8-17), and cervical carcinoma (2.4, 1.1-4.4). These three cancers were also increased in the combined periods. Risks of five non-AIDS-defining cancers were increased in the combined periods: Hodgkin lymphoma (5.7, 1.2-17) and cancers of the conjunctiva (SIR 4.0; 1.5-8.7), kidney (16, 1.8-58), thyroid (5.7, 1.1-16), and uterus (5.5, 1.5-14). Cancers of the breast, nasopharynx, and lung were increased either in the early or late incident periods only. Among 407 children, seven cancers were observed, of which five were Kaposi sarcoma. The application of a record-linkage design in Africa broadens the repertoire of epidemiological tools for studying HIV-infected populations. We confirm the increased risks of AIDS-defining cancers and report increased risks of a few non-AIDS-defining cancers.

Intimate partner violence against women in eastern Uganda: implications for HIV prevention

Abstract: Background We were interested in finding out if the very low antenatal VCT acceptance rate reported in Mbale Hospital was linked to intimate partner violence against women. We therefore set out to i) determine the prevalence of intimate partner violence, ii) identify risk factors for intimate partner violence and iii) look for association between intimate partner violence and HIV prevention particularly in the context of the prevention of mother-to-child transmission of HIV programme (PMTCT).

Mortality in HIV-infected and uninfected children of HIV-infected and uninfected mothers in rural Uganda.

Abstract: Objective: To estimate 2-year mortality rates in HIV-1Yinfected and uninfected infants born to HIV + and HIV j mothers. Methods: Data are from a prospective study in rural Rakai District, Uganda. Infant HIV status (determined by polymerase chain reaction) was evaluated at 1 to 6 weeks postpartum and during breastfeeding, and maternal HIV viral load and CD4 levels were measured at the postpartum visit. Multivariate Cox proportional hazards models and Kaplan-Meier survival analysis were used to assess survival of infants by maternal and infant HIV status and by quartiles of viral load. Log-rank tests were used to test the equality of survival functions. Results: Of the 4604 pregnant women, 16.9% were HIV + , and the proportion of children infected was 20.9%. Median survival of HIV-infected infants was 23 months. Two-year child mortality rates were 128 of 1000 children born to HIV j mothers, 165.5 of 1000 uninfected children born to HIV + mothers, and 540.1 of 1000 HIVinfected children (P G 0.0001). Compared with children of HIV j mothers, the hazard of child mortality was 2.04 (P G 0.001) if the mother was HIV + and 3.78 (P G 0.001) if the infant was also infected. In the adjusted model, the highest quartiles of log10 HIV viral load in infants and mothers were associated with significantly increased hazard of child mortality (hazard ratio [HR] = 8.54 and HR = 2.50, respectively). Maternal CD4 counts G200 cells/mL were also significant predictors of child mortality (HR = 2.61). A total of 67.6% of HIV-infected children with viral loads above the median died by the age of 2 years and are in need of early antiretroviral therapy (ART). Conclusions: More than half of HIV-infected infants died at less than 2 years of age. Therefore, ART may need to be initiated earlier in HIV-infected African children.

Using knowledge brokering to promote evidence-based policy-making: the need for support structures

Abstract: Knowledge brokering is a promising strategy to close the "know-do gap" and foster greater use of research findings and evidence in policy-making. It focuses on organizing the interactive process between the producers and users of knowledge so that they can co-produce feasible and research-informed policy options. We describe a recent successful experience with this novel approach in the Netherlands and discuss the requirements for effective institutionalization of knowledge brokering. We also discuss the potential of this approach to assist health policy development in low-income countries based on the experience of developing the Regional East-African Health (REACH)-Policy Initiative. We believe that intermediary organizations, such as regional networks, dedicated institutional mechanisms and funding agencies, can play key roles in supporting knowledge brokering. We recommend the need to support and learn from the brokerage approach to strengthen the relationship between the research and policy communities and hence move towards a stronger culture of evidence-based policy and policy-relevant research.

ICT usage and its impact on profitability of SMEs in 13 African Countries

Abstract: This paper reports on a small and medium enterprise (SME) Survey carried out by the ResearchICTAfrica (RIA) in 14 African countries. It argues that the negative return on investment reported in the literature can be attributed to the failure to distinguish between the formal and informal sectors. This paper demonstrates that informal SMEs have a higher profitability than formal ones. It further shows that ICTs are input factors for informal as well as formal SMEs. The paper argues that there is still demand for fixed line phones amongst SMEs, but that mobile phones have become the default communications tool because fixed lines are either too expensive or not available. The primary policy recommendation arising out of this is that applications for SMEs need to be developed using mobile phones.

Selection of Plasmodium falciparum pfmdr1 Alleles following Therapy with Artemether-Lumefantrine in an Area of Uganda where Malaria Is Highly Endemic

Abstract: Polymorphisms in the Plasmodium falciparum pfmdr1 gene were assayed in pretreatment samples and in samples from patients reinfected following therapy with artemether-lumefantrine. The pfmdr1 alleles 86N, 184F, and 1246D significantly increased in prevalence after treatment. All samples had a single pfmdr1 copy. Treatment with artemether-lumefantrine selects for polymorphisms that may alter antimalarial drug response.

Effect of HIV-1 Infection on Antimalarial Treatment Outcomes in Uganda: A Population-Based Study

Abstract: Human immunodeficiency virus (HIV) infection may increase the burden of malaria by increasing susceptibility to infection or by decreasing the response to antimalarial treatment. We investigated the seroprevalence rate of HIV-1 infection and its effect on antimalarial treatment outcomes in adults and children with uncomplicated falciparum malaria in Uganda. This retrospective study included 1965 patients = 18 months old who were randomized to receive 1 of 3 antimalarial regimens at 7 sites in Uganda. HIV-1 testing was performed using 2 enzyme-linked immunosorbent assays and Western blot analysis of stored blood spots. The primary study outcome was clinical treatment failure at 28 days after antimalarial treatment. Molecular genotyping was used to distinguish clinical treatment failures due to new infections from those due to recrudescences. The HIV-1 seroprevalence rate was 2.5% in 1802 patients 3-fold (hazard ratio [HR] 3.28 [95% confidence interval {CI} 1.25-8.59]) increased risk of clinical treatment failure for adults but there was no increased risk for HIV-1-infected children. Molecular genotyping revealed that clinical treatment failures were due to new infections (HR 6.35 [95% CI 1.64-24.5]) rather than to recrudescences (HR 1.51 [95% CI 0.27-8.58]). The HIV-1 seroprevalence rate was surprisingly high in adults presenting with malaria. This finding supports the implementation of routine HIV counseling and testing for adults with uncomplicated falciparum malaria. HIV-1 infection increased the susceptibility to new malarial infections but did not increase the risk of recrudescences in adults. (authors)

Postpartum major depression at six weeks in primary health care: prevalence and associated factors

Abstract: Background: Major depression is a common and disabling complication of the postpartum period in women. It is thought to occur three times more commonly in the developing than in developed countries. Objectives: The objectives of this study were to determine the prevalence of and factors associated with major depression among women attending a peri-urban primary health care unit in Kampala, Uganda, at six weeks postpartum. Method: Five hundred and fourty four women attending a peri-urban health centre were investigated in a cross-sectional study. These women were screened using the twenty five-item Self Reporting Questionnaire (SRQ-25), while major depression was confirmed using the Mini International Neuro-psychiatric Interview (MINI). Associations were sought between major depression and the respondents’ demographics and various psychological, social and obstetric factors. Results: The point prevalence of major depression at six weeks postpartum was 6.1%. Psychiatric disorder was significantly associated with young age, being single, negative life events, unplanned pregnancy, unwanted sex of baby and current physical illness in both mother and newborn. Conclusion: There is indication for routine screening of at risk women in the peri-natal period to avoid, recognize and manage postpartum psychiatric morbidity and its consequence on mothers and their developing children. African Health Sciences 2006; 6(4):207-214

Prevalence of antibodies to Brucella spp. and individual risk factors of infection in traditional cattle, goats and sheep reared in livestock-wildlife interface areas of Zambia.

Abstract: Pre-print to the original published by SpringerLink accessible on: http://www.springerlink.com/content/8r11190t71tg0080/

Interactions between a crinivirus, an ipomovirus and a potyvirus in coinfected sweetpotato plants

Abstract: Novel and severe symptoms of chlorosis, rugosity, leaf strapping and dark green islands, designated as sweetpotato severe mosaic disease (SPSMD), were caused by dual infection of Sweet potato mild mottle virus (SPMMV; Ipomovirus ) and Sweet potato chlorotic stunt virus (SPCSV; Crinivirus ) in three East African sweetpotato cultivars (Tanzania, Dimbuka and New Kawogo). The storage root yield was reduced by ∼ 80%, as compared with healthy plants under screenhouse conditions in Uganda. Plants infected with SPMMV or SPCSV alone showed nonsignificant or 50% yield reduction, respectively. SPCSV reduced resistance to SPMMV in sweetpotato, similar to the situation with resistance to Sweet potato feathery mottle virus (SPFMV; Potyvirus ) that breaks down following infection with SPCSV, followed by development of sweet potato virus disease (SPVD). In single virus infections with SPMMV and SPFMV or their coinfection, cvs Tanzania and Dimbuka were initially systemically infected, displayed symptoms and contained readily detectable virus titres, but new leaves were symptomless with very low virus titres, indicating recovery from disease. In contrast, cv. New Kawogo remained symptomless and contained low SPMMV and SPFMV titres following graft inoculation. These moderate and high levels of resistance to SPMMV and SPFMV, respectively, were lost and cultivars succumbed to a severe disease following coinfection with SPCSV. The synergistic interactions increased titres of SPMMV and SPFMV RNA by ∼ 1000fold as quantified by real-time PCR, whereas SPCSV titres were reduced twofold, indicating an antagonistic interaction. Coinfection with SPMMV and SPFMV caused no detectable changes in virus titres or symptom severity.

Nanoindentation measurements of the mechanical properties of polycrystalline Au and Ag thin films on silicon substrates: Effects of grain size and film thickness

Abstract: This paper presents the results of nanoindentation experimental studies of the contact-induced deformation in Au and Ag thin films. The paper examines the effects of film thickness and substrate deformation restraint on the mechanical properties of electron beam (e-beam) deposited Au and Ag films. Following a brief description of film microstructure, surface topography, and contact-induced pile-up deformation, film mechanical properties (hardness and Young's modulus) were determined using nanoindentation techniques. The indentation size effects (ISE) observed in films with different thicknesses were explained using a mechanism-based strain gradient (MSG) theory. The intrinsic film yield strengths and hardnesses extracted from the MSG theory are shown to exhibit classical Hall–Petch dependence on the inverse square root of the average film grain size. Displacement bursts were also found to occur in Ag films at indentation load levels of 100 μN. These were attributed to the initial onset of dislocation slip activity, when the shear stress exceeds the estimated theoretical shear strengths of the materials.

Predictors of poor anthropometric status among children under 2 years of age in rural Uganda

Abstract: The objective was to assess predictors of poor anthropometric status among infants and young children. Design: Cross-sectional survey. Setting: The rural subsistence agricultural district of Hoima western Uganda. Subjects: Seven hundred and twenty children aged 0--23 months with their mothers/carers. Methods: Participants were recruited in September 2002 using a two-stage cluster sampling methodology. A structured questionnaire was administered to mothers in their home settings. Information on health household socio-economic status child feeding practices and anthropometric measurement was gathered. Conditional logistic regression analysis was applied taking into account the hierarchical relationships between potential determinants of poor anthropometric status. The mean Z-score for weight-for-height was 20.2 (95% confidence interval (CI) 20.1 20.7) for height-for-age was 21.1 (95% CI 21.2 20.9) and for weight-for-age was 20.7 (95% CI 20.8 20.6). Wasting was independently associated only with a history of fever in the 2 weeks prior to the survey (odds ratio (OR) = 4.4 95% CI 1.5 13) while underweight was associated with a history of fever (OR = 2.4 95% CI 1.3 4.4) and cough (OR = 3.0 95% CI 1.3 6.8). Stunting was positively associated with a wider range of factors including: history of a fever episode (OR = 1.7 95% CI 1.0 2.9) lack of a latrine in the household (OR = 2.7 95% CI 1.5 4.9) failure to deworm children 12 months or older (OR = 1.7 95% CI 1.1 2.8) and being born to a non-formally educated mother compared with mothers educated above primary school (OR = 2.1 95% CI 1.1 4.0). In analyses guided by the hierarchical interrelationships of potential determinants ofmalnutrition wasting and underweight turned out to be independently predicted by morbidity (proximal) factors. Stunting however was predicted by socioeconomic (distal) environmental and health-care (intermediate) factors in addition to morbidity. Strategies aimed at improving the growth of infants and young children in rural communities should address morbidity due to common childhood illness coupled with environmental and socio-economically oriented measures. (authors)

Antiretroviral therapy improves cognitive impairment in HIV+ individuals in sub-Saharan Africa.

Abstract: Background: Highly active antiretroviral therapy (HAART) can improve cognitive performance in some patients with HIV-associated cognitive impairment in the United States. The effect of HAART on HIV dementia in sub-Saharan Africa is largely unknown. Objective: To evaluate neuropsychological test and functional performance in HIV+ individuals after 3 and 6 months of HAART in Uganda. Methods: Twenty-three HIV+ individuals receiving HAART also received a detailed clinical history, neuropsychological testing, and a functional assessment. Follow-up evaluations were performed at 3 and 6 months after baseline. Longitudinal changes in the HIV dementia stage, the mean Z score for each neuropsychological test, and the Karnofsky Functional Performance Scale were evaluated at 3 and 6 months. Results: The mean (SD) CD4 cell count improved from 71 (15) at baseline to 161 (30) at 3 months ( p = 0.005) and 222 (46) at 6 months ( p p p Conclusion: Highly active antiretroviral therapy (HAART) can be associated with improvement in neurocognitive and functional performance in HIV+ individuals in sub-Saharan Africa. These results suggest that HAART, if available in areas with limited resources in sub-Saharan Africa, should be provided for patients with HIV-associated cognitive impairment.

Health, Neurologic, and Cognitive Status of HIV-Infected, Long-Surviving, and Antiretroviral-Naive Ugandan Children

Abstract: OBJECTIVE. The purpose of this study was to assess the health status and school-age neurodevelopmental progress of antiretroviral treatment (ARVT)–naive, HIV-infected Ugandan children who had been followed as part of cohorts of children born to HIV-infected and -noninfected mothers between 1989 and 1993. METHODS. Twenty-eight children, aged 6 to 12 years, vertically infected with HIV-1 and never treated with ARVT were evaluated in terms of health status, neurologic, and psychometric testing. A randomly selected group of 42 seroreverters and 37 HIV-1 negative children who were age- and gender-matched and who had been followed in the same cohorts were evaluated also. The families studied were homogenous in their socioeconomic status. None of the mothers or children had received ARVT or been exposed to illicit drugs. RESULTS. The HIV-infected children showed significantly more evidence of acute malnutrition. They also had more illness, especially parotitis, otitis media, upper respiratory infections, and lymphadenopathy. However, they did not differ significantly in neurologic and cognitive assessments when compared with age- and gender-matched seroreverter and HIV-negative children. They were in the normal range with respect to neurologic and psychometric development measures. CONCLUSIONS.These children seem to represent a significant subgroup of HIV-infected child survivors for whom the progress of the disease is less aggressive throughout early life. Given the fact that many infants, especially in developing countries, continue to be born without the benefit of perinatal ARVT, there will likely continue to be many older HIV-infected children in the same situation as those described in this follow-up study. They will not have been recognized as being HIV-infected. It is important that such children be identified and offered access to ARVT and other appropriate support services.

The in-vitro antibacterial activity of Annona senegalensis , Securidacca longipendiculata and Steganotaenia araliacea - Ugandan medicinal plants

Abstract: Background: Nearly all cultures from ancient times to the present day have used plants as a source of medicines. As a result, different remedies tended to develop in different parts of the world. Current strategies to overcome the global problem of antimicrobial resistance include research in finding new and innovative antimicrobials from plants. Objectives: To determine the antibacterial activity of extracts of Annona senegalensis, Securidacca longipendiculata and Steganotaenia araliacea, plants which are used in Eastern Uganda for the treatment of diarrhea and wound infections. Methods: The root barks of these plants were collected, sun-dried, pounded using pestles and wooden mortars. Water and methanol extracts were derived and screened. Standard cultures of E. coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853, and Staphylococcus aureus ATCC 25923 were used in the study. The antibacterial tests used were the agar well diffusion assays. The minimum inhibitory concentrations (MIC) were determined by cylinder plate technique. Results: Extracts of Annona senegalensis, Steganotaenia araliacea and Securidaca longipendiculata showed activity against Staphylococcus aureus. The methanol extract of Securidaca longipediculata was not inhibitory to S.aureus. Steganotaenia araliacea and Securidaca longipediculata (water) extracts were active against all the bacteria tested. The water and methanol extracts of Annona senegalensis did not show inhibitory activity against E. coli. Of the three bacteria studied, Staphylococcus aureus was the most susceptible to the extracts followed by P. aeruginosa. E. coli was least sensitive to the plant extracts. Annona senegalensis had the lowest MIC against Staphylococcus aureus (62.5mg/ml); while Steganotaenia araliacea had the highest MIC (250mg/ml) signifying lower activity. Conclusions: The root bark extracts of the three plants showed antibacterial activity, justifying their continued use in treatment of bacterial infections. Recommendations: Further studies are required to isolate and characterise the active phytochemical constituents in the plants. Toxicity studies should be done to determine their safety. African Health Sciences 2006; 6(1): 31-35

Bacteraemia among severely malnourished children infected and uninfected with the human immunodeficiency virus-1 in Kampala, Uganda.

Abstract: To establish the magnitude of bacteraemia in severely malnourished children, and describe the types of bacteria and antimicrobial sensitivity by HIV status Isolates were recovered from 76 blood specimens Antibiotic susceptibility tests were performed using commercial antibiotic disks and demographic and clinical findings were recorded Of the 450 children 63% were male; median age 170 months (inter quartile range, IQR 12–24) and 57% had oedema 151 (367 %) of 411 tested HIV-positive; 76 (171%) of 445 blood specimens grew bacterial isolates; 58% were Gram negative – S typhimurium (276%) and S enteriditis (118%) Staph aureus (263%) and Strep pneumoniae (132%) were the main Gram positive organisms There was no difference in the risk of bacteraemia by HIV status, age < 24 months, male sex, or oedema, except for oral thrush (OR 23 CI 10–51) and hypoalbuminaemia (OR 35 CI 10–121) Isolates from severely immuno-suppressed children (CD4% <15%) were more likely to grow Salmonella enteriditis (OR 54; CI 16 – 174) The isolates were susceptible (≥ 80%) to ciprofloxacin, ceftriaxone and gentamicin; with low susceptibility to chlorampenicol, ampicillin (< 50%) and co-trimoxazole (<25%) Suspicion of bacteraemia had 959% sensitivity and 992% specificity Among bacteraemic children, mortality was higher (435% vs 205%) in the HIV-positive; OR 30 (95%CI 10, 86) Bacteraemia affects 1 in every 6 severely malnourished children and carries high mortality especially among the HIV-positive Given the high level of resistance to common antibiotics, there is need for clinical trials to determine the best combinations of antibiotics for management of bacteraemia in severely malnourished children

Response to antiretroviral therapy in HIV-infected patients attending a public, urban clinic in Kampala, Uganda.

Abstract: Background. Access to antiretroviral therapy and human immunodeficiency virus (HIV) care is increasing in resource-limited settings. We evaluated clinical, behavioral, and demographic risk factors associated with virologic suppression in a public, urban clinic in Kampala, Uganda. Methods. We conducted a cross-sectional, observational study of 137 HIV-infected patients who were receiving antiretroviral therapy at the infectious diseases clinic at Mulago Hospital (Kampala). We measured the prevalence of viral suppression, evaluated risk factors associated with virologic failure, and documented phenotypic resistance patterns and genotypic mutations. Results. A total of 91 (66%) of 137 participants had an undetectable viral load (<400 copies/mL) after a median duration of 38 weeks (interquartile range, 24-62 weeks) of antiretroviral therapy. Median CD4 cell count was 163 cells/mm 3 (interquartile range, 95-260 cells/mm 3 ). The majority of the patients (91%) were treated with nonnucleoside reverse-transcriptase inhibitor-based 3-drug regimens. In multivariate analysis, treatment with the first antiretroviral regimen was associated with viral suppression (odds ratio, 2.6; 95% confidence interval, 1.1-6.1). In contrast, a history of unplanned treatment interruption was associated with virologic treatment failure (odds ratio, 0.2; 95% confidence interval, 0.1-0.6). Of 124 participants treated with nonnucleoside reverse-transcriptase inhibitors, 27 (22%) were documented to have experienced virologic treatment failure. The most common mutation detected was K103N (found in 14 of 27 patients with virologic treatment failure). Conclusions. Although many HIV-infected people treated in Kampala, Uganda, have advanced HIV disease, the majority of patients who received antiretroviral therapy experienced viral suppression and clinical benefit. Because of the frequent use of nonnucleoside reverse-transcriptase inhibitor-based therapy, the majority of resistance was against this drug class. In resource-limited settings, initiation of therapy with a potent, durable regimen, accompanied by stable drug supplies, will optimize the likelihood of viral suppression.

Domestic violence during pregnancy and risk of low birthweight and maternal complications: a prospective cohort study at Mulago Hospital, Uganda

Abstract: Summary Objectives To investigate whether domestic violence during pregnancy is a risk factor for antepartum hospitalization or low birthweight (LBW) delivery. Methods A prospective cohort study was conducted in Mulago hospital, Kampala, Uganda, among 612 women recruited in the second pregnancy trimester and followed up to delivery, from May 2004 through July 2005. The exposure (physical, sexual or psychological violence during pregnancy) was assessed using the Abuse Assessment Screen. The relative and attributable risks of LBW and antepartum hospitalization were estimated using multivariate logistic regression analysis. Results The 169 women [27.7% 95% CI (24.3–31.5%)] who reported domestic violence during pregnancy did not differ significantly from the unexposed regarding sociodemographic characteristics, but differed significantly (P < 0.05) regarding domicile variables (had less household decision-making power, more resided in extended families and more had unplanned pregnancy). They delivered babies with a mean birthweight 2647.5 ± 604 g, on average 186 g [(95% CI 76–296); P = 0.001] lower than those unexposed. After adjusting for age, parity, number of living children, pregnancy planning, domicile and number of years in marriage, the relative risk (RR) of LBW delivery among women exposed to domestic violence was 3.78 (95% CI 2.86–5.00). Such women had a 37% higher risk of obstetric complications (such as hypertension, premature rupture of membranes and anaemia) that necessitated antepartum hospitalization [RR 1.37 (95% CI 1.01–1.84)]. Conclusion In this pregnancy cohort, domestic violence during pregnancy was a risk factor for LBW delivery and antepartum hospitalization. Objectifs Evaluer si les violences conjugales durant la grossesse sont un facteur de risque pour l'hospitalisation avant-terme et l'insuffisance ponderale a la naissance (IPN). Methodes Une etude de cohorte prospective a ete conduite, de Mai 2004 a Juillet 2005, a l'hopital Mulago (Kampala, Ouganda) parmi 612 femmes recrutees durant leur deuxieme trimestre de grossesse et suivies jusqu’a leur accouchement. L'exposition (violences physiques, sexuelles ou psychologiques durant la grossesse) etaient evaluees a l'aide de l'Echelle d'Evaluation des Abus (« Abuse Assessment Screen »). Les risques relatifs et attribuables d'insuffisance ponderale a la naissance et d'hospitalisation avant terme ont ete estimes en utilisant une analyse multivariee en regression logistique. Resultats Concernant les caracteristiques socio-demographiques, il n'y avait pas de difference significative entre les 169 femmes (27.7%; IC 95% [24.3; 31.5%]) rapportant des violences conjugales durant leur grossesse et les non exposees. Par contre elle differaient de facon significative (P < 0,05) en ce qui concernait les variables familiales (elles avaient moins de pourvoir decisionnel concernant le menage, residaient plus souvent dans des familles nombreuses et elles avaient plus de grossesse non planifiees). Elles ont donne naissance a des bebes ayant un poids moyen de naissance de 2647.5 ± 604 g, soit 186 g (IC 95% [76; 296]; P = 0.001) de moins par rapport aux non exposees. Apres ajustement sur l’âge, la parite, le nombre d'enfants vivants, les grossesses planifiees, le domicile et le nombre d'annees de mariage, le risque relatif d'IPN parmi les femmes exposees a des violences conjugales etaient de 3.78 (IC 95% [2.86; 5,00]). Ces femmes avaient un risque plus eleve de 37% de faire des complications obstetricales (hypertension, ruptures prematurees des membranes et anemies) necessitant une hospitalisation avant terme (RR 1.37; IC 95% [1.01; 1.84]). Conclusion Dans cette cohorte de femme enceintes, les violences conjugales pendant la grossesse etaient un facteur de risque pour l'IPN et l'hospitalisation avant terme. Objectivos Investigar si la violencia domestica durante la gravidez es un factor de riesgo de hospitalizacion previa al parto o bajo peso al nacer (LBW). Metodos Se realizo un estudio con una cohorte prospectiva en el hospital de Mulago, en Kampala, Uganda, entre 612 mujeres reclutadas en el segundo trimestre de gravidez, y controladas hasta el parto, desde mayo de 2004 hasta julio de 2005. La exposicion (violencia fisica, sexual o sicologica durante la gravidez) se establecio utilizando la Encuesta de Valoracion del Maltrato (Abuse Assessment Screen – ASS). El relativo y atribuible riesgo de bajo peso al nacery de hospitalizacion previa al parto se estimo utilizando un analisis de regresion logistica multivariable. Resultados Las 169 mujeres [27.7% 95% CI (24.3–31.5%)] que informaron de violencia domestica durante la gravidez no diferian significativamente de las no expuestas en relacion a las caracteristicas socio demograficas, pero difirieron significativamente (P < 0.05) en relacion a variables domesticas (tenian menor poder de decision en el hogar, muchas vivian en familias extendidas y muchas habian tenido una gravidez no planificada). Tuvieron ninos con un peso medio al nacer de 2647.5 ± 604 g, de promedio 186 g [(95% CI 76–296); P = 0.001] por debajo de las no expuestas. Luego de hacer los ajustes por edad, paridad, numero de ninos vivos, planificacion de gravidez, domicilio y numero de anos de matrimonio, el riesgo relativo de bajo peso al nacer entre las mujeres expuestas a violencia domestica fue de 3.78 (95% CI 2.86–5.00). Este tipo de mujeres tenian un 37% mayor de riesgo de complicaciones obstetricas (como por ejemplo hipertension, ruptura prematura de membranas y anemia), y de necesidad de hospitalizacion anterior al parto [RR 1.37 (95% CI 1.01–1.84)]. Conclusiones En esta cohorte de gravidez, la violencia domestica durante el embarazo fue un factor de riesgo para partos con bajo peso al nacer y hospitalizacion anterior al parto.

Low Levels of RANTES Are Associated with Mortality in Children with Cerebral Malaria

Abstract: BACKGROUND: In children with cerebral malaria (CM), serum chemokine levels and associated morbidity and mortality have not been characterized. METHODS: Serum levels of the cytokines interleukin (IL)-1 beta , IL-6, IL-10, interferon (IFN)-gamma, and tumor necrosis factor-alpha and the chemokines macrophage inflammatory protein (MIP)-1 alpha, MIP-1 beta, and regulated upon activation, normal T cell expressed and secreted (RANTES) were measured in Ugandan children with CM, in children with uncomplicated malaria (UM), and in healthy children from the community, as control subjects (CCs). RESULTS: Children with CM had lower levels of RANTES and higher levels of all other cytokines and chemokines than CCs (all P<.0001), and they had lower levels of RANTES (P=.004) and higher levels of IL-10 (P=.003), IFN-gamma (P=.007), and IL-1 beta (P=.05) than children with UM. Children with CM who died had lower levels of RANTES (P=.006) and higher of levels of IL-6 (P=.006), IL-10 (P=.01), IFN-gamma (P=.03), and MIP-1 beta (P=.008) than children who survived. After adjustment for other cytokine and chemokine levels, only low levels of RANTES were independently associated with mortality (P=.016). Levels of RANTES correlated with platelet count but were associated with mortality independently of platelet count. CONCLUSIONS: The serum cytokine and chemokine profile of children who die of CM is similar to that of individuals who die of sepsis. Levels of RANTES are significantly lower in children with CM, and very low levels of RANTES are associated with mortality, independently of other cytokine and chemokine levels.

Artemisinin combination therapies for treatment of uncomplicated malaria in Uganda.

Abstract: Objectives: To compare the efficacy and safety of artemisinin combination therapies for the treatment of uncomplicated falciparum malaria in Uganda.

Tuberculosis immune reconstitution inflammatory syndrome in countries with limited resources.

Abstract: Mycobacterium tuberculosis infection accounts for probably one third of human immunodeficiency virus (HIV) related immune reconstitution inflammatory syndrome (IRIS) events, particularly in developing countries where HIV and tuberculosis (TB) co-infection is very common. Small cohort studies of HIV-positive patients with active TB treated with antiretroviral therapy (ART) suggest an incidence of TB IRIS varying between 11% and 45%. Risk factors for TB IRIS that have been suggested in certain studies but not in others include: starting ART within 6 weeks of starting TB treatment; extra-pulmonary or disseminated disease; a low CD4+ lymphocyte count and a high viral load at the start of ART; and a good immunological and virological response during highly active antiretroviral therapy (HAART). It is important to agree on a clinical case definition of TB IRIS that could be used in resource-limited settings. Such a case definition could be used to determine the exact incidence and consequences of TB IRIS and would be valuable worldwide in clinical trials that are needed to answer questions on how this phenomenon could be prevented and treated.

How revolutionary is the “nerica revolution”? evidence from uganda

Abstract: A new high-yielding upland rice variety known as New Rice for Africa (NERICA) has been widely recognized as a promising technology for addressing the food shortage in sub-Saharan Africa However, there has been no on-farm yield data to support this optimism The present study attempts to assess the actual and potential yield of NERICA in Uganda where it has been introduced recently We found that NERICA's yield is higher (25 tons) for farmers who had rice-growing experience than those who had no previous experience (17 tons) These findings strongly indicate that strengthening training, extension, and other supporting systems is the key to the success of the “NERICA revolution” in this country

Escaping poverty and becoming poor in 36 villages of Central and Western Uganda

Abstract: Twenty-four per cent of households in 36 village communities of Central and Western Uganda have escaped from poverty over the past 25 years, but another 15 per cent have simultaneously fallen into poverty. A roughly equal number of households escaped from poverty in the first period (ten to 25 years ago) as in the second period (the last ten years) examined here. However, almost twice as many households fell into poverty during the second period as in the first period. Progress in poverty reduction has slowed down as a result. Multiple causes are associated with descent into poverty and these causes vary significantly between villages in the two different regions. For nearly two-thirds of all households in both regions, however, ill health and health-related costs were a principal reason for descent into poverty. Escaping poverty is also associated with diverse causes, which vary across the two regions. Compared to increases in urban employment, however, land-related reasons have been more import...