Showing papers by "Makerere University published in 2007"

Boys are more stunted than girls in Sub-Saharan Africa: a meta-analysis of 16 demographic and health surveys

Abstract: Many studies in sub-Saharan Africa have occasionally reported a higher prevalence of stunting in male children compared to female children. This study examined whether there are systematic sex differences in stunting rates in children under-five years of age, and how the sex differences in stunting rates vary with household socio-economic status. Data from the most recent 16 demographic and health surveys (DHS) in 10 sub-Saharan countries were analysed. Two separate variables for household socio-economic status (SES) were created for each country based on asset ownership and mothers' education. Quintiles of SES were constructed using principal component analysis. Sex differentials with stunting were assessed using Student's t-test, chi square test and binary logistic regressions. The prevalence and the mean z-scores of stunting were consistently lower amongst females than amongst males in all studies, with differences statistically significant in 11 and 12, respectively, out of the 16 studies. The pooled estimates for mean z-scores were -1.59 for boys and -1.46 for girls with the difference statistically significant (p < 0.001). The stunting prevalence was also higher in boys (40%) than in girls (36%) in pooled data analysis; crude odds ratio 1.16 (95% CI 1.12–1.20); child age and individual survey adjusted odds ratio 1.18 (95% CI 1.14–1.22). Male children in households of the poorest 40% were more likely to be stunted compared to females in the same group, but the pattern was not consistent in all studies, and evaluation of the SES/sex interaction term in relation to stunting was not significant for the surveys. In sub-Saharan Africa, male children under five years of age are more likely to become stunted than females, which might suggest that boys are more vulnerable to health inequalities than their female counterparts in the same age groups. In several of the surveys, sex differences in stunting were more pronounced in the lowest SES groups.

Treatment interruptions predict resistance in HIV-positive individuals purchasing fixed-dose combination antiretroviral therapy in Kampala, Uganda.

Abstract: The objective was to evaluate adherence treatment interruptions and outcomes in patients purchasing antiretroviral fixed-dose combination (FDC) therapy Ninety-seven participants were recruited into a prospective 24-week observational cohort study of HIV-positive antiretroviral-naive individuals initiating self-pay Triomune or Maxivir therapy in Kampala Uganda Adherence was measured by monthly structured interview unannounced home pill count and electronic medication monitors (EMM) Treatment interruptions were measured as continuous intervals greater than 48 h without opening the EMM The primary outcomes were survival with viral suppression below 400 copies/ml CD4 cell increases and genotypic drug resistance at 24 weeks The median baseline CD4 cell count was 56 cells/ml and median log10 copies RNA/ml was 554; mean adherence ranged from 82 to 95% for all measures but declined significantly over time In an intent-to-treat analysis 70 (72%) patients had an undetectable plasma HIV-RNA level at week 24 Sixty-two of 95 (65%) individuals with continuous EMM data had a treatment interruption of greater than 48 h Treatment interruptions accounted for 90% of missed doses None of 33 participants who did not interrupt treatment for over 48 h had drug resistance whereas eight of 62 (13%) participants who did interrupt therapy experienced drug resistance Antiretroviral resistance was seen in 8% of individuals and overall mortality was 10% at 24 weeks HIV-positive individuals purchasing generic FDC antiretroviral therapy have high rates of adherence and viral suppression low rates of antiretroviral resistance and robust CD4 cell responses Adherence is an important predictor of survival with full viral suppression Treatment interruptions are an important predictor of drug resistance (authors)

Cognitive Impairment After Cerebral Malaria in Children: A Prospective Study

Abstract: OBJECTIVE. This study was conducted to assess prospectively the frequency of cognitive deficits in children with cerebral malaria. METHODS. Cognitive testing in the areas of working memory, attention, and learning was performed for Ugandan children 5 to 12 years of age with cerebral malaria (n = 44), children with uncomplicated malaria (n = 54), and healthy community children (n = 89) at admission and 3 and 6 months later. RESULTS. Six months after discharge, 21.4% of children with cerebral malaria had cognitive deficits, compared with 5.8% of community children. Deficits were seen in the areas of working memory (11.9% vs 2.3%) and attention (16.7% vs 2.3%). Children with cerebral malaria had a 3.7-fold increased risk of a cognitive deficit, compared with community children, after adjustment for age, gender, nutritional status, school level, and home environment. Among children with cerebral malaria, those with a cognitive deficit had more seizures before admission (mean: 4.1 vs 2.2) and a longer duration of coma (43.6 vs 30.5 hours), compared with those without a deficit. Children with uncomplicated malaria did not have an increased frequency of cognitive deficits. CONCLUSIONS. Cerebral malaria may be a major cause of cognitive impairment in children in sub-Saharan Africa. Cognitive deficits in children with cerebral malaria are more likely for those who have multiple seizures before effective treatment for cerebral malaria.

Expanding access to voluntary HIV counselling and testing in sub-Saharan Africa: alternative approaches for improving uptake, 2001-2007.

Abstract: The changing face of the HIV/AIDS epidemic has resulted in new opportunities to increase access to voluntary HIV counselling and testing (VCT), especially during the past 7 years (2001-2007) As access to HIV treatment becomes more widely available in sub-Saharan Africa, the need for enhanced access to VCT would become even greater When given the opportunity, many more adults in sub-Saharan African would accept VCT, and many clearly express the desire to learn their HIV sero-status However, in most parts of sub-Saharan Africa, fewer than one in 10 people know their HIV status Stigma, fear of receiving an HIV-positive status, lack of confidentiality, long distances to VCT sites, and long delays in returning HIV test results limit people's access to traditional VCT systems Alternative VCT delivery models, such as mobile VCT, routine offer of VCT and home-based VCT increase access to and uptake of VCT We recommend that these alternative models be implemented in more settings and on a much larger scale in sub-Saharan Africa, where VCT uptake rates remain low

Hormonal contraception and the risk of HIV acquisition.

Abstract: Combined oral contraceptives (COC) and depot-medroxyprogesterone acetate (DMPA) are among the most widely used family planning methods; their effect on HIV acquisition is not known. The objective was to evaluate the effect of COC and DMPA on HIV acquisition and any modifying effects of other sexually transmitted infections. Methods: This multicenter prospective cohort study enrolled 6109 HIV-uninfected women aged 18-35 years from family planning clinics in Uganda Zimbabwe and Thailand. Participants received HIV testing quarterly for 15-24 months. The risk of HIV acquisition with different contraceptive methods was assessed (excluding Thailand where there were few HIV cases). HIV infection occurred in 213 African participants (2.8/100 woman-years). Use of neither COC [hazard ratio (HR) 0.99; 95% confidence interval (CI) 0.69-1.42] nor DMPA (HR 1.25; 95% CI 0.89-1.78) was associated with risk of HIV acquisition overall including among participants with cervical or vaginal infections. While absolute risk of HIV acquisition was higher among participants who were seropositive for herpes simplex virus 2 (HSV-2) than in those seronegative at enrolment among the HSV-2-seronegative participants both COC (HR 2.85; 95% CI 1.39-5.82) and DMPA (HR 3.97; 95% CI 1.98-8.00) users had an increased risk of HIV acquisition compared with the non-hormonal group. No association was found between hormonal contraceptive use and HIV acquisition overall. This is reassuring for women needing effective contraception in settings of high HIV prevalence. However hormonal contraceptive users who were HSV-2 seronegative had an increased risk of HIV acquisition. Additional research is needed to confirm and explain this finding. (authors)

Growing problem of Multidrug-Resistant enteric pathogens in Africa

Abstract: Control of fecal-orally transmitted pathogens is inadequate in many developing countries, in particular, in sub-Saharan Africa. Acquired resistance to antimicrobial drugs is becoming more prevalent among Vibrio cholerae, Salmonella enteritidis, diarrheagenic Escherichia coli, and other pathogens in this region. The poor, who experience most of the infections caused by these organisms, bear the brunt of extended illness and exacerbated proportion of deaths brought about by resistance. Improved antimicrobial drug stewardship is an often cited, but inadequately implemented, intervention for resistance control. Resistance containment also requires improvements in infectious disease control, access to and quality assurance of antimicrobial agents, as well as diagnostic facilities. Structural improvements along these lines will also enhance disease prevention and control as well as rational antimicrobial drug use. Additionally, more research is needed to identify low-cost, high-impact interventions for resistance control.

Factors affecting the productivity of building craftsmen ‐ studies of Uganda

Abstract: Poor productivity of construction workers is one of the causes of cost and time overruns in construction projects. The productivity of labour is particularly important especially in developing countries, where most of the building construction work is still on manual basis. This paper reports on a survey made on project managers of building projects in Uganda, where an increase in productivity is being sought. Respondents were required to rate using their experience how 36 factors affect productivity with respect to time, cost and quality. The survey was carried out by a questionnaire and responses received over a period of 3 months. The ten most significant problems affecting labour productivity were identified as incompetent supervisors; lack of skills from the workers; rework; lack of tools/equipment; poor construction methods; poor communication; inaccurate drawings; stoppages because of work being rejected by consultants; political insecurity; tools/equipment breakdown; and harsh weather con...

Predictors of long-term viral failure among ugandan children and adults treated with antiretroviral therapy.

Abstract: Background: HIV RNA viral load testing is costly and is generally unavailable in resource-limited settings. We identified predictors of viral failure and documented genotypic mutations in a subset of patients with viral failure after 12 months on antiretroviral therapy (ART). Methods: From April 2004 to June 2005, consecutive treatment-naive patients beginning ART at a university clinic in Uganda were enrolled. Clinical information, CD4 cell count, and HIV RNA level were collected at baseline and every 3 to 6 months. Independent predictors of viral failure were identified using multivariate logistic regression. Genotypic drug resistance for 8 patients with viral failure at 12 months was measured at baseline and at 6 and 12 months. Results: Five hundred twenty-six adults and 250 children (0 to 18 years of age) were started on first-line ART regimens and followed for 12 months. Outcomes could not be assessed in 13% of patients (79 died and 21 were withdrawn). Children were almost twice as likely to have viral failure compared with adults (26% vs. 14%; P = 0.0001). In adults, the sole independent predictor of viral failure was treatment with stavudine (d4T)/lamivudine (3TC)/nevirapine (NVP) versus zidovudine (ZDV)/3TC/efavirenz (EFV) (odds ratio [OR] = 2.59, 95% confidence interval [CI]: 1.20 to 5.59). In children, independent predictors of viral failure included male gender (OR = 2.44, 95% CI: 1.20 to 4.93), baseline CD4% <5 (OR = 2.69, 95% CI: 1.28 to 5.63), and treatment with d4T/3TC/NVP versus ZDV/3TC/EFV (OR = 2.46, 95% CI: 1.23 to 4.90). All 8 patients with viral breakthrough and genotypic drug resistance results had nonnucleoside reverse transcriptase inhibitor (NNRTI)- and 3TC-associated mutations. Conclusions: These data demonstrate the effectiveness of ART in a low-resource setting. Children and patients of all ages taking the d4T/3TC/NVP regimen were more likely to have viral failure. Our data suggest that viral failure occurring 6 months or more after the start of ART regimens commonly used in Uganda is likely to be associated with NNRTI- and 3TC-resistant virus.

Burkitt's lymphoma in Africa, a review of the epidemiology and etiology

Abstract: Burkitt’s lymphoma (BL) was first described in Eastern Africa, initially thought to be a sarcoma of the jaw. Shortly it became well known that this was a distinct form of Non Hodgkin’s lymphoma. The disease has given insight in all aspects of cancer research and care. Its peculiar epidemiology has led to the discovery of Epstein Barr virus (EBV) and its importance in the cause of several viral illnesses and malignancies. The highest incidence and mortality rates of BL are seen in Eastern Africa. BL affects mainly children, and boys are more susceptible than girls. Evidence for a causal relationship between EBV and BL in the endemic form is fairly strong. Frequency of association between EBV and BL varies between different patient groups and different parts of the world. EBV may play a role in the pathogenesis of BL by deregulation of the oncogene c-MYC by chromosomal translocation. Although several studies suggest an association between malaria and BL, there has never been a conclusive population study in support of a direct role of malaria in causation of BL. The emergence of HIV and a distinct subtype of BL in HIV infected have brought a new dimension to the disease particularly in areas where both HIV and BL are endemic. BL has been reported as a common neoplasm in HIV infected patients, but not in other forms of immuno-depression, and the occurrence of BL seems to be higher amongst HIV positive adults, while the evidence of an association amongst children is still disputed. The role of other possible risk factors such as low socio-economical status, exposure to a plant species common in Africa called Euphorbiaceae, exposure to pesticies and to other infections such as schistosomiasis and arbovirus (an RNA virus transmitted by insect vectors) remain to be elucidated. African Health Sciences 2007; 7(3): 166-175

Coreceptor Tropism in Human Immunodeficiency Virus Type 1 Subtype D: High Prevalence of CXCR4 Tropism and Heterogeneous Composition of Viral Populations

Abstract: In human immunodeficiency virus type 1 (HIV-1) subtype B, CXCR4 coreceptor use ranges from 20% in early infection to 50% in advanced disease. Coreceptor use by non-subtype B HIV is less well characterized. We studied coreceptor tropism of subtype A and D HIV-1 collected from 68 pregnant, antiretroviral drug-naive Ugandan women (HIVNET 012 trial). None of 33 subtype A or 10 A/D-recombinant viruses used the CXCR4 coreceptor. In contrast, nine (36%) of 25 subtype D viruses used both CXCR4 and CCR5 coreceptors. Clonal analyses of the nine subtype D samples with dual or mixed tropism revealed heterogeneous viral populations comprised of X4-, R5-, and dual-tropic HIV-1 variants. In five of the six samples with dual-tropic strains, V3 loop sequences of dual-tropic clones were identical to those of cocirculating R5-tropic clones, indicating the presence of CXCR4 tropism determinants outside of the V3 loop. These dual-tropic variants with R5-tropic-like V3 loops, which we designated “dual-R,” use CCR5 much more efficiently than CXCR4, in contrast to dual-tropic clones with X4-tropic-like V3 loops (“dual-X”). These observations have implications for pathogenesis and treatment of subtype D-infected individuals, for the association between V3 sequence and coreceptor tropism phenotype, and for understanding potential mechanisms of evolution from exclusive CCR5 use to efficient CXCR4 use by subtype D HIV-1.

Insecticide-treated nets for the prevention of malaria in pregnancy: A systematic review of randomised controlled trials

Abstract: Background Protection from malaria with insecticide-treated bednets (ITNs) during pregnancy is widely advocated, but evidence of benefit has been inconsistent. We undertook a systematic review of randomised trials. Methods and Findings Three cluster-randomised and two individually randomised trials met the inclusion criteria; four from Africa (n = 6,418) and one from Thailand (n = 223). In Africa, ITNs compared to no nets increased mean birth weight by 55 g (95% confidence interval [CI] 21-88), reduced low birth weight by 23% (relative risk [RR] 0.77, 95% CI 0.61-0.98), and reduced miscarriages/stillbirths by 33% (RR 0.67, 0.47-0.97) in the first few pregnancies. Placental parasitaemia was reduced by 23% in all gravidae (RR 0.77, 0.66-0.90). The effects were apparent in the cluster-randomised trials and the one individually randomised trial in Africa. The trial in Thailand, which randomised individuals to ITNs or untreated nets, showed reductions in anaemia and fetal loss in all gravidae, but not reductions in clinical malaria or low birth weight. Conclusions ITNs used throughout pregnancy or from mid-pregnancy onwards have a beneficial impact on pregnancy outcome in malaria-endemic Africa in the first few pregnancies. The potential impact of ITNs in pregnant women and their newborns in malaria regions outside Africa requires further research.

A molecular link between malaria and Epstein-Barr virus reactivation.

Abstract: Although malaria and Epstein-Barr (EBV) infection are recognized cofactors in the genesis of endemic Burkitt lymphoma (BL), their relative contribution is not understood. BL, the most common paediatric cancer in equatorial Africa, is a high-grade B cell lymphoma characterized by c-myc translocation. EBV is a ubiquitous B lymphotropic virus that persists in a latent state after primary infection, and in Africa, most children have sero-converted by 3 y of age. Malaria infection profoundly affects the B cell compartment, inducing polyclonal activation and hyper-gammaglobulinemia. We recently identified the cystein-rich inter-domain region 1alpha (CIDR1alpha) of the Plasmodium falciparum membrane protein 1 as a polyclonal B cell activator that preferentially activates the memory compartment, where EBV is known to persist. Here, we have addressed the mechanisms of interaction between CIDR1alpha and EBV in the context of B cells. We show that CIDR1alpha binds to the EBV-positive B cell line Akata and increases the number of cells switching to the viral lytic cycle as measured by green fluorescent protein (GFP) expression driven by a lytic promoter. The virus production in CIDR1alpha-exposed cultures was directly proportional to the number of GFP-positive Akata cells (lytic EBV) and to the increased expression of the EBV lytic promoter BZLF1. Furthermore, CIDR1alpha stimulated the production of EBV in peripheral blood mononuclear cells derived from healthy donors and children with BL. Our results suggest that P. falciparum antigens such as CIDR1alpha can directly induce EBV reactivation during malaria infection that may increase the risk of BL development for children living in malaria-endemic areas. To our knowledge, this is the first report to show that a microbial protein can drive a latently infected B cell into EBV replication.

Drug sensitivity patterns of bacterial isolates from septic post-operative wounds in a regional referral hospital in Uganda

Abstract: Background: Wound infections have been a problem in the field of surgery for a long time.Advances in control of infections have not completely eradicated this problem because of development of drug resistance.Antimicrobial resistance can increase complications and costs associated with procedures and treatment. Objective: A study was carried out on drug sensitivity patterns of bacterial isolates from septic postoperative wounds in Jinja hospital, Uganda.This study was designed to determine the distribution of bacterial pathogens isolated from septic post-operative wounds and their antimicrobial susceptibility patterns. Method: Specimens of pus swabs were collected aseptically and analysed in the laboratory. Colony characteristics and Grams technique were used to differentiate the organisms. Biochemical tests were done to confirm the species of the organisms. Sensitivity testing was done on the isolates using the disk diffusion method. Results: Pathogenic bacteria were recovered from 58.5% of the specimens.The isolates were: S.aureus (45.1%), Coliforms (16.9%), Proteus mirabilis (11.3%), P.aeruginosa (9.9%), Klebsiella pneumoniae (7.0%) and Enterobacter spp (2.82%). Most of the organisms were sensitive to gentamicin, ciprofloxacin and ceftazidime.There was resistance to ampicillin, amoxycillin and chloramphenicol. Staphylococcus aureus was generally sensitive to gentamicin (87.5%), ciprofloxacin (68.7%) and methicillin (75%), but resistant to erythromycin (56.2%) and ampicillin (97%). Most of the gram-negative bacteria isolated (Coliforms, P.aeruginosa , E.coli , Proteus mirabilis , and Klebsiella pneumoniae ) were sensitive to Ciprofloxacin, Gentamicin and Ceftazidime but resistant to Ampicillin,Amoxycillin and Chloramphenicol. Methicillin-resistant Staphylococcus aureus (MRSA) strains formed 25% of this species. Pseudomonas aeruginosa was sensitive to gentamicin (87.5%) and ceftazidime (85.7%) but showed resistance to ciprofloxacin (57.2%). Some organisms e.g. S.aureus, Pseudomonas aeruginosa and Proteus mirabilis exhibited multi-drug resistance to the antibiotics tested. Conclusion: Since a high proportion of samples had positive cultures, infection control is recommended as a strategy to minimise spread of resistant organisms. It is recommended that gentamicin, ciprofloxacin and ceftazidime be used in preference to ampicillin and amoxycillin for treatment of septic wounds.There is need to develop national surveillance of antibiotic- resistant organisms. African Health Sciences Vol. 7 (3) 2007: pp. 148-154

Food security status in households of people living with HIV/AIDS (PLWHA) in a Ugandan urban setting.

Abstract: Because HIV/AIDS negatively impacts on the food security status of households, it is crucial to identify how households respond to these impacts, in order to identify positive food security entry points and design strategies that can effectively alleviate food insecurity among the households of people living with HIV/AIDS (PLWHA). A cross-sectional study was thus undertaken to establish how HIV affected households in an urban Ugandan setting in terms of response to food shortages and the interrelations between the practice of agriculture by PLWHA households within and around town, food security, access to food aid and dietary diversity among these households. Data for this cross-sectional study were collected using quantitative methods from 144 randomly recruited households of PLWHA (aged 15-49 years) residing in Jinja town in Eastern Uganda. The study showed that the HIV/AIDS pandemic has increased the inability of affected households in the study area to put enough food on the table, possibly because of the continued decreased productivity in these households and the high expenditure on medical costs. Various coping mechanisms identified in the households of PLWHA may contribute to poor adherence to antiretroviral regimes and poor quality of life for all household members. However, the practice of agriculture by PLWHA households was one of the positive coping mechanisms to alleviate food insecurity.

Low adherence to exclusive breastfeeding in Eastern Uganda: A community-based cross-sectional study comparing dietary recall since birth with 24-hour recall

Abstract: Exclusive breastfeeding is recommended as the best feeding alternative for infants up to six months and has a protective effect against mortality and morbidity. It also seems to lower HIV-1 transmission compared to mixed feeding. We studied infant feeding practices comparing dietary recall since birth with 24-hour dietary recall. A cross-sectional survey on infant feeding practices was performed in Mbale District, Eastern Uganda in 2003 and 727 mother-infant (0–11 months) pairs were analysed. Four feeding categories were made based on WHO's definitions: 1) exclusive breastfeeding, 2) predominant breastfeeding, 3) complementary feeding and 4) replacement feeding. We analyzed when the infant fell into another feeding category for the first time. This was based on the recall since birth. Life-table analysis was made for the different feeding categories and Cox regression analysis was done to control for potential associated factors with the different practices. Prelacteal feeding practices were also addressed. Breastfeeding was practiced by 99% of the mothers. Dietary recall since birth showed that 7% and 0% practiced exclusive breastfeeding by 3 and 6 months, respectively, while 30% and 3% practiced predominant breastfeeding and had not started complementary feeding at the same points in time. The difference between the 24-hour recall and the recall since birth for the introduction of complementary feeds was 46 percentage points at two months and 59 percentage points at four months. Prelacteal feeding was given to 57% of the children. High education and formal marriage were protective factors against prelacteal feeding (adjusted OR 0.5, 0.2 – 1.0 and 0.5, 0.3 – 0.8, respectively). Even if breastfeeding is practiced at a very high rate, the use of prelacteal feeding and early introduction of other food items is the norm. The 24-hour recall gives a higher estimate of exclusive breastfeeding and predominant breastfeeding than the recall since birth. The 24-hour recall also detected improper infant feeding practices especially in the second half year of life. The dietary recall since birth might be a feasible alternative to monitor infant feeding practices in resource-poor settings. Our study reemphasizes the need for improving infant feeding practices in Eastern Uganda.

Artemether-Lumefantrine versus Dihydroartemisinin-Piperaquine for Treatment of Malaria: A Randomized Trial

Abstract: Objectives: To compare the efficacy and safety of artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP) for treating uncomplicated falciparum malaria in Uganda. Results: Of 421 enrolled participants, 417 (99%) completed follow-up. The unadjusted risk of recurrent falciparum parasitemia was significantly lower for participants treated with DP than for those treated with AL after 28 d (11% versus 29%; risk difference (RD) 18%, 95% confidence interval (CI) 11%-26%) and 42 d (43% versus 53%; RD 9.6%, 95% CI 0%-19%) of follow-up. Similarly, the risk of recurrent parasitemia due to possible recrudescence (adjusted by genotyping) was significantly lower for participants treated with DP than for those treated with AL after 28 d (1.9% versus 8.9%; RD 7.0%, 95% CI 2.5%-12%) and 42 d (6.9% versus 16%; RD 9.5%, 95% CI 2.8%-16%). Patients treated with DP had a lower risk of recurrent parasitemia due to non-falciparum species, development of gametocytemia, and higher mean increase in hemoglobin compared to patients treated with AL. Both drugs were well tolerated; serious adverse events were uncommon and unrelated to study drugs.

Available technologies to replenish soil fertility in East Africa

Abstract: Low inherent soil fertility in the highly weathered and leached soils largely accounts for low and unsustained crop yields in most African countries. But in particular, the major nutrients, nitrogen (N) and phosphorus (P), are commonly deficient in these soils. This scenario of nutrient depletion is reflected in food deficits and hence the food aid received continuously, specifically in sub-Saharan Africa. Undoubtedly, substantial efforts have been made in the continent to replenish the fertility of degraded soils in attempts to raise crop yields, towards self-sufficiency and export. Such efforts consist of applications of both organic and inorganic resources to improve the nutrient status of soils and enhanced nutrient uptake by crops, provided that soil moisture is adequate. Overall, positive crop responses to these materials have been obtained. Thus in the East African region, maize (staple) yields have been raised in one growing season from below 0.5 t/ha without nutrient inputs, to 3–5 t/ha from various nutrient amendments at the smallhold farm level. However, in spite of the positive crop responses to nutrient inputs, farmers are generally slow to adopt the soil fertility management technologies. In this paper we review the impact of some technologies, focussing the use of nutrient resources of different characteristics (qualities) in relation to improved crop yields, with an overall goal to enhance technology adoption. Thus, inorganic resources or fertilizers often give immediate crop responses, but their use or adoption is rather restricted to large-scale farmers who can afford to buy these materials. Organic resources, which include crop residues, water hyacinth and agroforestry shrubs and trees, are widely distributed, but they are generally of low quality, reflecting the need to apply large quantities to meet crop nutrient demands. Moreover, most organics will add N mainly to soils. On the other hand, phosphate rocks of varying reactivity are found widely in Africa and are refined elsewhere to supply soluble P sources. The recently developed soil fertility management options in East Africa have targeted the efficient use of N and P by crops and the integrated nutrient management approach. Some people have also felt that the repackaging of inputs in small, affordable quantities, such as the PREP-PAC described in this paper, may be an avenue to attract smallhold farmers to use nutrient inputs. Nonetheless, crop responses to nutrient inputs vary widely within and across agroecozones (AEZs), suggesting specificity in recommendations. We highlight this observation in a case study whereby eight soil fertility management options, developed independently, are being tested side- by-side at on-farm level. Farmers will be empowered to identify technologies from their own choices that are agronomically effective and economically friendly. This approach of technology testing and subsequent adoption is recommended for technology development in future.

Limitations of rapid HIV-1 tests during screening for trials in Uganda: diagnostic test accuracy study

Abstract: Objective To evaluate the limitations of rapid tests for HIV-1. Design Diagnostic test accuracy study. Setting Rural Rakai, Uganda. Participants 1517 males aged 15-49 screened for trials of circumcision for HIV prevention. Main outcome measures Sensitivity, specificity, negative predictive values, and positive predictive values of an algorithm using three rapid tests for HIV, compared with the results of enzyme immunoassay and western blotting as the optimal methods. Results Rapid test results were evaluated by enzyme immunoassay and western blotting. Sensitivity was 97.7%. Among 639 samples where the strength of positive bands was coded if the sample showed positivity for HIV, the algorithm had low specificity (94.1%) and a low positive predictive value (74.0%). Exclusion of 37 samples (5.8%) with a weak positive band improved the specificity (99.6%) and positive predictive value (97.7%). Conclusion Weak positive bands on rapid tests for HIV should be confirmed by enzyme immunoassay and western blotting before disclosing the diagnosis. Programmes using rapid tests routinely should use standard serological assays for quality control. Trial registration Clinical Trials NCT00425984.

Explanatory Models and Help-Seeking Behavior: Pathways to Psychiatric Care Among Patients Admitted for Depression in Mulago Hospital, Kampala, Uganda

Abstract: In this article, the authors present findings from a qualitative study exploring how people diagnosed with depression conceptualize their condition and how their conceptualization shaped their efforts to seek help. They used an interview guide based on an explanatory model framework for data collection. Four major themes emerged from the analysis: (a) somatization, social meaning of illness, and help seeking; (b) meaning and perceived consequences of illness; (c) How did I get here? Making sense of psychiatric admission; and (d) variations in the causal attribution and the role of significant others in help seeking. Somatization of emotional problems, variations in causal attribution between patients and their significant others, the nature of the available health care system, and burden of infectious disease complicate access to care. These findings suggest the need to raise the awareness of primary care providers on how to recognize and help people with depression appropriately in this setting.

The impact of male circumcision on HIV incidence and cost per infection prevented: a stochastic simulation model from Rakai, Uganda.

Abstract: The objectives were to estimate the impact of male circumcision on HIV incidence the number of procedures per HIV infection averted and costs per infection averted. A stochastic simulation model with empirically derived parameters from a cohort in Rakai Uganda was used to estimate HIV incidence assuming that male circumcision reduced the risks of HIV acquisition with rate ratios (RR) ranging from 0.3 to 0.6 in men their female partners and in both sexes combined with circumcision coverage 0-100%. The reproductive number (R0) was also estimated. The number of HIV infections averted per circumcision was estimated from the incident cases in the absence of surgery minus the projected number of incident cases over 10 years following circumcision. The cost per procedure ($69.00) was used to estimate the cost per HIV infection averted. Baseline HIV incidence was 1.2/100 person-years. Male circumcision could markedly reduce HIV incidence in this population particularly if there was preventative efficacy in both sexes. Under many scenarios with RR = 0.5 circumcision could reduce R0 to < 1.0 and potentially abort the epidemic. The number of surgeries per infection averted over 10 years was 19-58 and the costs per infection averted was $1269-3911 depending on the efficacy of circumcision for either or both sexes assuming 75% service coverage. However behavioral disinhibition could offset any benefits of circumcision. Male circumcision could have substantial impact on the HIV epidemic and provide a cost-effective prevention strategy if benefits are not countered by behavioral disinhibition. (authors)

Active biomonitoring of trace heavy metals using fish (Oreochromis niloticus) as bioindicator species. The case of Nakivubo wetland along Lake Victoria

Abstract: The Nakivubo wetland in Uganda, which feeds Lake Victoria at Murchison bay, has become severely degraded over recent years and is particularly threatened by the expansion of industry, settlement and cultivation on its fertile fringes. The aim of this study was to actively biomonitor selected trace heavy metals using Nile tilapia (Oreochromis niloticus). Nile tilapia was set in cages at six sampling sites in Murchison bay for a period of six weeks, and sampling was done every 2 weeks for active biomonitoring and weekly for physico-chemical variables. The control (site 7) was at the Aquaculture Research and Development centre, Uganda. Fish tissue was dissected and gills, liver and muscle removed for heavy metal analysis. Water samples and fish tissue from each site were analysed using Atomic Absorption Spectrophotometer (AAS) to determine metal concentrations of zinc, copper, chromium and manganese. Site 4 had the highest average NH4–N of 14.28 ± 12.73 mg/l which was above effluent standards for Uganda. From the findings, there were significantly higher concentrations of heavy metals in fish than in water (p > 0.01). Fish kills were recorded highest for sites 4 (55%), 5 (77.5%) and 6 (60%) in less than six weeks indicating high levels of pollution. Gills showed the highest accumulation of copper after a period of six weeks as compared to other metals with a mean ± SE of 11.7 μg/mg wet weight. In general, the order of accumulation of metals in tissue after six weeks was in order; copper > zinc > chromium > manganese and gills > liver > muscle. In conclusion, active biomonitoring was found to be a good tool for monitoring water quality as it integrates responses to combinations of all contaminants thereby indicating overall effects in a water body. To improve the study, there is need to incorporate post mortem studies and biomarker analysis since the later can give early warning of pollution before fish kills are observed.

Family Caregivers in Rural Uganda: The Hidden Reality

Abstract: We conducted 16 in-depth interviews with family caregivers of AIDS patients in three rural districts in western Uganda. They were selected from a client visitation list of the home-based care program for AIDS patients, based on volunteer participation. Family caregivers reported huge problems associated with providing the necessary psychological, social, and economic care. They also said that the physical and emotional demands of caregiving are overwhelming daily challenges. Most support to AIDS patients provided by family, friends, and the churches. The study highlights the great burden of caregivers, in sub-Saharan Africa who most often are elderly women and young girls. This study examine, the burden and related health issues of family caregivers, primarily women, for AIDS patients in Uganda. It was part of a broad research project using qualitative methods on family caregiving in the home environment in sub-Saharan Africa. As the requirements for family care giving are often overwhelming for women under the conditions as they exist in Uganda and in other developing countries, it constitutes a gender issue of great importance that has not been appreciated fully in the international literature. Family caregiving is also of international relevance, as HIV/AIDS is a global pandemic of previously unknown proportions. In many poor countries, family caregiving is the most common and often the only care that AIDS patients receive, because clinic-based care often is not available close to home or is not affordable. Therefore, family caregiver support programs to alleviate this burden are essential for all those countries where HIV/AIDS is prevalent. Family caregiver burden encompasses medical, social, and economic issues at the household level, which requires an interdisciplinary approach in order to fully understand and appreciate the different dimensions of the family caregiver burden and its negative impact on the lives of so many women in so many countries.