OBSTACLES TO FAMILY PLANNING USE AMONG RURAL WOMEN IN ATIAK HEALTH CENTER IV, AMURU DISTRICT, NORTHERN UGANDA.

BACKGROUND: Uganda's rapid population growth (3.2%) since 1948 has placed more demands on health sector and lowered living standard of Ugandans resulting into 49% of people living in acute poverty especially in post conflict Northern Uganda. The population rise was due to low use of contraceptive methods (21% in rural areas and 43% in urban areas) and coupled with high unmet need for family planning (41%). This indicated poor access to reproductive health services. Effective use of family planning could reduce the rapid population growth. OBJECTIVE: To determine obstacles to family planning use among rural women in Northern Uganda. DESIGN: A descriptive cross-sectional analytical study. SETTING: Atiak Health Centre IV, Amuru District, rural Northern Uganda. SUBJECTS: Four hundred and twenty four females of reproductive ages were selected from both Inpatient and Outpatient Departments of Atiak Health Centre IV. RESULTS: There was high level of awareness 418 (98.6%), positive attitude 333 (78.6%) and fair level of utilisation 230 (54.2%) of family planning. However, significant obstacles to family planning usage included; long distance to Health facility, unavailability of preferred contraceptive methods, absenteeism of family planning providers, high cost of managing side effects, desire for big family size, children dying less than five years old, husbands forbidding women from using family planning and lack of community leaders' involvement in family planning programme. CONCLUSIONS: In spites of the high level of awareness, positive attitude, and free family planning services, there were obstacles that hindered family planning usage among these rural women. However, taking services close to people, reducing number of children dying before their fifth birthday, educating men about family planning, making sure family planning providers and methods are available, reducing cost of managing side effects and involving community leaders will improve utilisation of family planning and thus reduce the rapid population growth and poverty.

REASSESSMENT OF HELMINTH INFECTIONS IN GULU MUNICIPALITY NOTHERN UGANDA AFTER THE TWENTY YEARS OF INSURGENCY: USING THREE DIAGONOSTIC METHODS TO COMPARE THEIR SENSITIVITY.

BACKGROUND: During the period of insurgency there were several internally displace people camps all over the Northern Uganda. People who lived within ten kilometers from Gulu Municipality were forced to evacuate their villages and re-locate and build huts for themselves in areas identified for them by the government. There were several of such camps within the municipality creating influx of people from the villages to the municipality for security. Now with the situation restored to normal, there is need to re-assess and update information on the prevalence of helminth infections in Gulu municipality where many of the internally displaced people (IDP) settled. OBJECTIVE: To find out if S. mansoni and soil transmitted nematode infections are so prevalent and very common in children aged betweenfive to 20 years. In Gulu municipality and that additional preventive and curative measure need to be considered. Further is there a strong need to reconsider more sensitive diagnostic methods at the hospitals or does the standard approach of direct smear examination recognise at least most heavy infected children with any of the parasites. Setting. The study was carried out in Gulu municipality. DESIGN: Purposive and random sampling methods were used. Study Population: Mainly Primary school children aged between five to 20 years randomly selected from four primary schools purposively selected around Gulu municipality were recruited for the study. For control 20 staff of each school randomly selected were also studied. RESULTS: Of the 582 samples tested, 117(20.1%) were found positive for Schistosoma mansoni. Fifteen (2.6%) other samples were found positive for other helminths like Ascaris lumbricoides, Trichuris trichiura H.nana Hookworm. The comparison between the methods showed that the results obtained by the three methods were similar for field research. There is a low intensity of infection with soil transmitted helminths found in the primary schools around Gulu municipality. CONCLUSION: We concluded that the prevalence and intensity of infection with soil transmitted helminths was low among the children aged between 5 to 20 years in the four primary school studied (2.6%) but there was medium infection with S.mansoi (20.1%). The sensitivity in detecting the helminthes eggs in the stool specimen were similar. Though the original Kato/Katz method recorded lowest egg count than the Polderman and Odongo-Aginya methods. This could be due to the fact that the slides were read immediately.

SCHISTOSOMA MANSONI INFECTION AND THE ASSOCIATED ANTIBODY IMMUNE RESPONSE AMONGST RESIDENTS OF KIGUNGU ENTEBBE, UGANDA.

UNLABELLED: BACNKGROUND: There are many foci endemic for Schistosoma (S.) mansoni in Uganda. The immune responses to infection with the parasites in these areas have been found to vary with host sex, age and infection intensity. OBJECTIVE: To determine the profile of antibody isotypes responses against S. mansoni crude soluble egg antigens (SEA) and soluble adult worm protein (SWAP) antigens that determine the host resistance or susceptibility to reinfection. DESIGN: Cross Sectional, cohort study. SETTING: Kigugu fishing village in Entebbe, Uganda. SUBJECTS: Nine hundred and forty five (945) Kigungu residents reported forpre-treatment screening and enrolment and 626 cohorts report for post-treatment screening and enrolment 18 months later. RESULTS: Pearson's Chi-sq2 showed thatincrease in titres of anti (SWAP IgE, SEA IgE, and SEA IgG2) was not significant, but increase in anti SEA IgG3 was significant. Decrease in titres of anti (SWAP IgG1, SEA IgG1, and SEA IgG4) was not significant but decrease of anti (SWAP IgG2, SWAP IgG3 and SWAP IgG4) was significant. Positive correlation existed between age and anti SWAP IgE in before and after treatment sera. On the contrary, age was positively correlated with anti SWAP IgG4 in pre-treatment sera but was negatively correlated with anti SWAP IgG4 in the post-treatment sera. In addition there were positive correlation between higher egg counts and the immunoglobulin levels of anti SWAP IgG4 and anti SEA IgG4 but negative correlations were observed between anti SWAP IgE and anti SEA IgE. Conversely low egg counts were associated with high levels of anti SWAP IgE. Furthermore, IgG1-4, IgE antibody to SEA and SWAP antigens did not differ significantly according to sex. CONCLUSION: We concluded that praziquantel treatment of S. mansoni infected persons alter the immune responses that are influenced by age and intensity. A phenomenon that is useful in the effort to produce vaccine against schistosome.

RISK FACTORS FOR ROAD TRAFFIC ACCIDENTS IN GULU MUNICIPALITY, UGANDA.

BACKGROUND: Currently Road Traffic Accidents (RTA) are ranked tenth among the leading causes of death and ninth among all leading causes of disability worldwide. There has been no published study on RTA in Gulu municipality. There is a high frequency of RTA in Gulu municipality with poor road design and inadequate knowledge on road safety precaution among road users. OBJECTIVES: To establish the causes of Road Traffic Accidents (RTA), establish the safety measures in place to protect road users to avoid RTA and establish people mostly involved and the mechanism of RTA. DESIGN: A cross-sectional study. SETTINGS: Four divisions of Gulu Municipality; Layibi, Laroo, Pece and Bardege. SUBJECTS: Two hundred and forty two participants including pedestrians, drivers of different categories of vehicles, motorcyclists and bicyclists locally known as boda-boda and the police were interviewed. RESULTS: Most respondents reported RTA as a problem in Gulu municipality (96%), causing death (48%), financial constraint due to medical treatment (41%) and disability (11%). The following causes of RTA were identified; reckless driving and riding (49%), poor road design (24%), drug abuse (15%) and over loading (12%). According to police records of January to September 2009 RTA involved pedestrians (36.34%), passengers (25.80%), motorcyclists (24.88%), pedal cyclists (11.52%) and drivers (3.68%). CONCLUSION: RTAs is a substantial burden in Gulu municipality in Northern Uganda with reckless driving or riding, poor road design, overloading, double parking, inadequate road safety signs and knowledge, were major risk factors. Efforts to reduce RTA in Gulu municipality should aim at addressing these problems.

Bilharzia induced pathologies and techniques of detection in Uganda: a review.

BACKGROUND: Schistosoma S. mansoni was observed and reported in Uganda in 1902. Schistosoma S. mansoni is widely distributed in Uganda along permanent water bodies. OBJECTIVE: To review the literature on previous techniques and conventional ones used for the assessment and comparison of morbidity due to schistosomiasis in Uganda. DESIGN: Retrospective study. SETTING: Gulu University, Faculty of Medicine, Department of Microbiology and Immunology. RESULTS: Since its first detection in 1902 Schistosomiasis mansoni and later Schistosomiasis haematobium in Uganda, morbidity assessment was based on physical examination and intensity of eggs excretion. The first field study in Uganda of schistosomiasis pathologies using ultrasound was that conducted in West Nile in Obongi, Rhino Camp and Pundu in 1991 and reviewed in 1992. These armless and none invasive method of pathologies detection has the advantage of repeatability. It showed that after treatment there was reversibility of pathological conditions introduced by the parasites in the hosts. CONCLUSION: Schistosomiasis mansoni pathologies as detected by the none invasive ultrasound findings compared well with those of the more risky invasive liver biopsy. The detection of pathologies by clinical examination was less sensitive. Pathological lesions due to S. haematobium correlated with abnormalities of the urinary tract and intensity of eggs in urine.

Effect of seasonal rainfall and other environmental changes, on snail density and infection rates with Schistosoma mansoni fifteen years after the last snails' study in Kigungu, Entebbe, Uganda.

BACKGROUND: The last study on snail population density in relation to rainfall pattern in Kigungu canoe landing and recreational sites on Lake Victoria shore was earlier carried out about fifteen years ago. This study also reviewed the influence of other environmental factors on the snails' infection rate. OBJECTIVE: To reassess the density dynamic of Biomphalaria (B) choanomphala and Biomphalaria (B) pfeifferi, which act as the intermediate host for S. mansoni and Bulinus (B) globosus, and Bulinus (B) tropicus, which act as intermediate host for S. haematobium. DESIGN: Retrospective study. SETTING: Busy canoe landing sites along Lake Victoria in Kigungu fishing village were selected for the snail sampling. RESULTS: Nine thousand one hundred and ninety four B. choanomphala were collected over the study period. The numbers of B. choanomphala collected in each yearwas 4742 (51.6%) and 4452 (48.4%) in 2004 and 2005 respectively. Of the 4742 B. Choanomphala collected in 2004, 82 (1.7%) shed human cercariae and 329 (6.7%) shed non-human cercariae. Whereas in 2005, out of 4452 B. choanomphala collected 302 (6.85%) shed non-human cercariae and 82 (1.8%) shed human cercariae. Similarly, 4173 B. pfeifferi were also collected in the same period. Out of which 2224 (53.3%) were collected in 2004 and 1949 (46.7%) in 2005. For B. pfeifferi, 42 (1.9%) out of 2224 snails collected in 2004 shed human cercariae and 246 (11.1%) shed non-human cercariae. While in 2005, 33 out of 1949 snails (1.7%) shed human cercariae and 159 (8.2%) shed non-human cercariae. Other snails of medical importance collected included 292 B. globosus and 3094 B. tropicus. None of the Bulinus spp. collected shed any human cercariae but 37 (2.1%) and 30 (2.3%) B. tropicus shed non-human cercariae in 2004 and 2005 respectively. In 2004 and 2005, the area received, 1729mm and 1959mm of rainfall respectively, The mean rainfall during the year was 144.05 mm and 163.3 mm in 2004 and 2005 respectively. There was a negative correlation between rainfalls and snail density dynamic. CONCLUSION: We have found in this study that in spite of the bush clearing of the papyrus swamps which originally was the major habitats for B. choanomphala, B. pfeifferi and the Bulinus spp the intermediate host for schistosome at all canoe landing sites at Kigungu, these snails are still present. Moreover, that their population density dynamic and infection rate are inversely proportional to the rainfall pattern.

Evidence for the occurrence of Schistosoma intercalatum at Albert Nile in northern Uganda.

During a field investigation in Rhino Camp at Albert Nile in northern Uganda, 77.8% of 636 persons excreted Schistosoma mansoni ova that were detected by the Kato-Katz method. Six patients, 8-17 years of age, had terminally spined schistosome eggs in their stools. These findings were confirmed when preserved specimens were examined at the Institute of Medical Parasitology in Bonn using a concentration technique. The mean +/- SD length of 36 terminally spined eggs was 156 +/- 6 microns and the mean +/- SD width was 59 +/- 3.6 microns. Urine filtration in the study patients revealed no schistosome eggs in the urine. It is concluded that these findings provide evidence for the occurrence of S. intercalatum at Albert Nile in northern Uganda.

A preliminary study on intermediate snail hosts of schistosomes in River Enyau, Arua district, Uganda.

A total of 1260 snail intermediate hosts of both Schistosoma mansoni and Schistosoma haemotobium were collected along the non-seasonal River Enyau which lies half a kilometre west of Arua, a north-western Uganda town. The snails collected were Biomphalaria pfeifferi 709: Biomphalaria choanomphala 457, Bulinus Bulinus tropicus 94. These were screened for cercariae shedding and 25 B. pfeifferi and 12 B. choanomphalal shed mammalian cercaricae while none of the Bulinus (Bulinus) tropicus shed any cercariae. River Enyau Biomphalaria snails were susceptible to a Schistosoma mansoni strain from Entebbe. Cercariae derived from these snails and also those found infected in the River Enyau were confirmed to be S. mansoni using laboratory mice.

The intensity of Schistosoma mansoni in the fishing villages of Bugonga and Kitubulu in Entebbe Peninsula, Uganda.

The intensity of Schistosoma mansoni infection in the fishing villages of Bugonga and Kitubulu, and the occurrence of snail intermediate host population in the two villages are described and compared. A total of five hundred and six faecal samples from both villages were examined by modified Kato's technique and the prevalence infection rate at Kitubulu was 40.3% with mean egg count of 187 eggs per gram(epg) while in Bugonga it was 32.4% and 126 epg respectively. The snail intermediate host for S. mansoni in the two villages was 2,750 Biomphalaria choanomphala at Kitubulu and 1,268 at Bugonga. But at Kitubulu in the vicinity of the village 185 Biomphalaria peifferi occurred in small localized population. The cercarial screening test conducted on 4,018 B. choanomphala and 185 B. peifferi from the two villages revealed higher snail infection rate for both mammalian and non-mammalian cercariae at Kitubulu than Bugonga. Variations in infection rates both among the inhabitants and host snail populations in the two villages are discussed.

Schistosomiasis on the Entebbe Peninsula.

A comparative study of the prevalence of Schistosoma mansoni and their intermediate host in the fishing villages of Nakiwogo and Kigungu is reported. A total of 520 inhabitants from the two villages were examined for Schistosoma mansoni. Their age varied from 4 to 40 and the infection was found to be higher at Nakiwogo 95(36.6%) than at Kigungu 40(15.4%). The snails collected were 1,345 Biomphalaria choanomphala, 237 Biomphalaria pfeifferi, 180 Bulinus (Bulinus) tropicus, 56 Bulinus (physopsis) globosus and other snails of non-medical importance like Pila ovata, Melanoides tuberculata and Bellamya species. Biomphalaria choanomphala was found to be the major intermediate host for Schistosoma mansoni in the two villages. The intermediate hosts for S. mansoni were screened for cercarial shedding, 2 Biomphalaria pfeifferi shed furcocercous cercariae and 9 Leptocercous cercariae while Biomphalaria choanomphala were an negative. The water contact activities related to infection in the two villages are discussed.

Schistosoma mansoni along Lake Albert, Kibale District, Western Uganda.

Four hundred and fifty one human strata living in the three fishing villages of Ndiaga, Kabukanga and Rwabikongoro along Lake Albert shore in Kibale District were examined for S. mansoni infection using Kato/Katz method. Of the 451 people, 409 (90.7%) were found infected with S. mansoni with geometric mean egg count of 561.3 eggs per gram (epg) faeces. Males had significantly higher mean egg counts than females, 608.3 epg and 415.6 epg respectively. All S. mansoni infected individuals were treated with praziquantel at 40 mg/kg body weight. Other common parasites observed were Asaris lumbricoides, Trichuris trichiura and hookworms. These were treated with mebendazole. Snail infection rate among the 115 Biomphalaria sudanica and the 56 B. stanleyi were 5.2% and 3.6% respectively. All the 66 Bulinus (B) tropicus found, were negative for cercariae shedding. The main pulmonate snails were 250 Lymnae natalensis, 500 Pila ovata and 375 Bellamya spp were the commonest prosobranchs followed by Bivalves (101).

Transmission of Schistosoma mansoni in Rhino Camp, Uganda.

Non-participant observations totalling 204 hours relevant to the transmission of Schistosoma mansoni infection were carried out in Rhino Camp at the shores of Albert Nile in North Uganda. A cross-sectional study of 636 individuals from Rhino Camp revealed a prevalence of S. mansoni infection of 77.8%. Occupational and domestic purposes were the most important reasons for water contact, whereas recreational purposes ranked lower and mainly concerned children. Both sexes were equally active in water contacts. A distinct preference of Nile water was noted despite availability of borehole water in the area. It is concluded that control measures against schistosomiasis have to take into consideration that water contact for recreational purposes might be minimized, whereas it is expected to be extremely difficult to reduce occupational and domestic water contacts.

PIP: Rhino Camp is one of the most important fishing and farming villages along the shores of Albert Nile in West Nile Province, Uganda. Ajagoro and Diova water contact sites were selected to observe water contact activities in November 1991 for 17 days during the rainy season. Cumulatively, 204 hours of observations during all times of the day were done by 2 experienced persons. The observation period covered 12 hours a day. Water contact activities were recorded up to 10 times per hour, 11-20 times per hour, and more than 20 tines per hour. A total of 157 individuals, 5-50 years old, were interviewed about tribal origin, reasons for water contact, previous status in exile, and attitudes towards Nile water. 636 individuals consisting of 155 school children, 208 fishermen and families, 247 individuals seeking admission to the study and 26 officials provided up to 2 stool samples. Fishing and water fetching was the most frequent reason for water contact at the sites. Water activities were highest in the morning and early afternoon and decreased markedly towards the evening. Children, fishers, subsistence cultivators, business people, and civil servants were involved in water activities. Children 5-9 years old were few, but individuals 10-39 years old had the highest frequencies of water contacts. A considerable proportion of observed water contacts were made by people who had been exiled from Zaire or Sudan. Individuals 10-39 years old made water contacts almost exclusively for domestic and economic reasons. Those below 5 years old came for recreational purposes. Prevalence of S. mansoni infection was 77.8% in the cross-sectional survey performed in 636 individuals. 5.5% of those had more than 500 eggs per gram stool. Little is known about the impact of water contact activities on the intensity of schistosomiasis in the area. Therefore, further ecological research is needed for future control of schistosomiasis at the community level along the river Nile.

Urban Schistosoma mansoni near Enyau river in Arua town, Uganda.

Using the Kato Katz method for quantification of parasitic eggs in faeces, 500 individuals aged between 4 and 50 years, living along River Enyau, half a kilometre from Arua town, were studied to assess the prevalence of Schistosoma mansoni in the population. The overall prevalence of Schistosoma mansoni infection was 62%. The infection was highest among school children (71.1%, i.e. 199 out of 280). Villagers who lived along the immediate vicinity of the river had a 62.8% prevalence of infection (98 out of 156). School teachers and the members of their families had the lowest infection rate (20.3% i.e. 13 out of 64). The geometric mean egg output for males and females in the community studied was 203 and 179 eggs per gram of stool, respectively. 206 (41%) out of 500 individuals had mixed infections of S. mansoni and hookworms. The rate of orally transmitted intestinal helminths like Trichuris trichiura was very low (0.8%). Ascaris lumbricoides eggs were not found.

Integrated control trial of schistosomiasis at Nakiwogo fishing village near Entebbe, Uganda.

Using the Kato Katz technique, 600 people living in Nakiwogo fishing village at Lake Victoria, Uganda, were examined for Schistosoma mansoni infection. The total population of this village was estimated between 1,000 and 1,500 mainly consisting of migrants from western Uganda. Of the 600 individuals in the study group, 328 people (54.7%) were found to be infected with S. mansoni. The geometric mean egg count was 422 eggs per gramme of stool. A survey of the snail intermediate hosts for S. mansoni and S. haematobium at Nakiwogo was carried out. The collected snails were tested for cercariae shedding. A significant decrease in the number of Biomphalaria choanomphala and Biomphalaria pfeifferi (52%) which both still shed cercariae and Bulinus tropicus (52.5%) could be observed. There was a lower none-significant decrease of 13.3% of the Bulinus globosus population. With a combined approach including community participation in control measures in the form of health education, sanitation, environmental management and chemotherapy, the prevalence of S. mansoni infection was reduced from 54.7% to 14.6% in the period of one year.

Evaluation of schistosoma mansoni morbidity one year after praziquantel treatment in rhino cAMP and obongi in west nile, Uganda.

An evaluation study on reversibility of Schistosoma mansoni induced periportal fibrosis (PF) morbidity following treatment with praziquantel, 40mg/kg body weight after one year, was carried out in Rhino Camp and Obongi all are West Nile districts in northern Uganda. To assess the reversibility of Schistosoma (S) mansoni induced PFs morbidity following treatment with praziquantel, 40mg/kg body weight after one year. The design was a Prospective cohorts study; and the setting was a busy canoe landing sites along Albert Nile in Schistosoma (S) mansoni hyperendemic areas of Rhino Camp and Obongi fishing village were selected for the study. Previously in 2005, 1562 people including fishermen and women, school pupils, teachers, and civil servants were studied in both fishing villages for S. mansoni using Kato/Katz stool smear method. Abdominal ultrasonography and sonomorphological abnormalities of periportal fibrosis were performed with Aloka portable ultrasound machine (Hellige, Freiburg, Germany) fitted with a convex probe of 3.5 mega Hertz was also performed in the field clinic on all patients who had S. mansoni eggs in their faeces. The sonomorphological abnormalities of periportal fibrosis were categorised and organomorphometry of liver and spleen was done. One thousand two hundred and seventy three 1273 (81.5%) patients in Rhino Camp and Obongi fishing villages were found to be excreting from 100 to ≥ 500 eggs per gram (epg) of faeces of S. mansoni eggs. Two hundred and eighty nine (18.5%) did not have eggs of S.mansoni in their faeces. All the 1273 patients secreting eggs of S.mansoni in their stool in Rhino Camp and Obongi fishing villages had abdominal ultrasonography and sonomorphological abnormalities of periportal fibrosis. Eight hundred and forty 840 (66%) although excreted S. mansoni eggs in their stool had Pf (0); Pf grade (I), n=259 (20.3%); Pf grade (II) n =147 (11.5%); and Pf grade (III) n=27 (2.1%) were observed.

Field evaluation of an improved Kato-Katz thick smear technique for quantitative determination of helminth eggs in faeces.

A new method for the quantification of helminth eggs in faeces was developed, in which 7.5% nigrosin in 10% formaldehyde mixed with 5% eosin yellow in 10% formaldehyde was substituted for the malachite green solution used in the standard Kato-Katz method. This modification revealed the eggs of parasites like Schistosoma mansoni, Ascaris lumbricoides, Trichuris trichiura and hookworms distinctly. The slides made with this new technique could be accurately read within one hour. Faecal smears from 100 pupils in Kigungu, Entebbe, Uganda, were studied with both methods. The egg counts of S. mansoni, A. lumbricoides and T. trichiura by both methods were equal. The modified method, however, showed significantly higher hookworm egg counts (p < 0.001). Hookworm eggs were equal one hour after preparation of the slides as 16 hours after preparation. The intensity of infection detected was higher with the modified method for both S. mansoni and hookworms.