Stigma and Associated Sex Disparities Among Patients with Tuberculosis in Uganda: A Cross-Sectional Study.

Background: Tuberculosis (TB) is one of the leading causes of death from a single infectious agent globally. Stigma associated with TB encompassing self-, anticipated-, and public-stigma has significant negative effects on treatment adherence. In Uganda, limited data exist on the prevalence of stigma and its relationship with sex among patients with TB. We evaluate prevalence of three types of stigma and their relationship with the sex of patients undergoing TB treatment. Methods: This cross-sectional study was conducted between July 2020 to March 2021 at selected TB clinics in Kampala, Uganda. Eligible participants were aged 18-65 with confirmed TB and starting their prescribed treatment. We collected data on socio-demographics and used 13 items to capture the self-, anticipated-, and public-stigma from which we composed the dependent variables. The primary independent variable was sex. We employed multivariable logistic regression analysis to evaluate the association between sex and the three stigma types. Additionally, we considered potential confounders such as age, HIV, and employment status. Statistical significance was defined as p<0.05. Results: In this study we enrolled 144 participants with a mean age of 35.8 years (standard deviation = 12). Half of the participants (50%, n=72) were female, 44% had a secondary education, 37.5% were unemployed, and 32.6% were co-infected with HIV. The prevalence of self-stigma was 71.1%, anticipated stigma was 75.7%, and public stigma was 41.7%. Significant factors were associated with self-stigma were female sex (adjusted odds ratio (AOR): 2.35 95% CI: 1.02-5.74) and unemployment (AOR: 2.95 95% CI: 1.16-8.58). HIV-positive status was significantly associated with anticipated stigma (AOR: 3.58 95% CI: 1.38-11.23). However, none of the variables we evaluated showed a significant association with public stigma. Conclusions: Our study showed a high prevalence of self, anticipated and public stigma among TB patients. Notably, females and unemployed individuals were at a higher risk of self-stigma, while those with HIV/AIDS and TB were more likely to report anticipated stigma. To combat stigma effectively, interventions should be tailored to cater to sex-specific needs and persons living with HIV. Future research should delve further in determinants of TB-related stigma in high-burden settings.

Availability and affordability of essential medicines and diagnostic tests for diabetes mellitus in Africa.

OBJECTIVE: To investigate the current status of the availability and affordability of specific essential medicines and diagnostics for diabetes in Africa. METHODS: Systematic review and meta-analysis. Studies conducted in Africa that reported any information on the availability and affordability of short-acting, intermediate-acting, and premixed insulin, glibenclamide, metformin, blood glucose, glycated haemoglobin or HbA1c, and lipid profile tests were included. Random-effect model meta-analysis and descriptive statistics were performed to determine the pooled availability and affordability, respectively. RESULTS: A total of 21 studies were included. The pooled availability of each drug was as follows: short-acting insulin 33.5% (95% CI: 17.8%-49.2%, I2  = 95.02%), intermediate-acting insulin 23.1% (95% CI: 6.3%-39.9%, I2  = 91.6%), premixed insulin 49.4% (95% CI: 24.9%-73.9%, I2  = 90.57%), glibenclamide 55.9% (95% CI: 43.8%-68.0%, I2  = 96.7%), and metformin 47.0% (95% CI: 34.6%-59.4%, I2  = 97.54%). Regarding diagnostic tests, for glucometers the pooled availability was 49.5% (95% CI: 37.9%-61.1%, I2  = 97.43%), for HbA1c 24.6% (95% CI: 3.1%-46.1%, I2  = 91.64), and for lipid profile tests 35.7% (95% CI: 19.4%-51.9%, I2  = 83.77%). The median (IQR) affordability in days' wages was 7 (4.7-7.5) for short-acting insulin, 4.4 (3.9-4.9) for intermediate-acting insulin, 7.1 (5.8-16.7) for premixed insulin, 0.7 (0.7-0.7) for glibenclamide, and 2.1 (1.8-2.8) for metformin. CONCLUSION: The availability of the five essential medicines and three diagnostic tests for diabetes in Africa is suboptimal. The relatively high cost of insulin, HbA1c, and lipid profile tests is a significant barrier to optimal diabetes care. Pragmatic country-specific strategies are urgently needed to address these inequities in access and cost.

Assessment of knowledge, attitude and practice of first aid among taxi operators in a Kampala City Taxi Park, Uganda: A cross-sectional study.

INTRODUCTION: Road traffic accidents are among the leading causes of death in Uganda. Taxi operators are at a high risk of RTA and can potentially be first responders. This study, aimed to assess knowledge, attitude, and practice of first aid among taxi operators in the new taxi park, Kampala Uganda. METHODS: A descriptive cross-sectional study was conducted in 2021 among taxi drivers and conductors in the New Taxi Park, Kampala City, Uganda. A semi-structured questionnaire was used to collect quantitative data from taxi operators after informed consent. Chi-square or Fisher's exact test and logistic regression were performed in STATA 16 to assess the association between first aid knowledge and demographics. P < 0.05 was statistically significant. RESULTS: A total of 345 participants, majority males (n = 338, 98%) aged between 18 and 45 years (76.5%), were recruited. Although 97.7% (n = 337) had heard about first aid, only 19.4% (n = 67) had prior first aid training. Overall mean knowledge score was 40.1% (SD = 14.5%), with 29.9% (n = 103) having good knowledge (≥50%). Participants who had witnessed more than five accidents (aOR = 2.9, 95% CI = 1.7-4.8, p < 0.001), those with first aid kits (aOR = 1.7, 95% CI = 1.0-3.0, p = 0.38) were more likely to have good knowledge while those below post-secondary education level i.e., Primary (AOR = 0.2, 95% CI = 0.1-0.5, p ≤0.001) and secondary (aOR = 0.2, 95% CI = 0.1-0.6, p = 0.001), were less likely to have good knowledge. About 97% and 93% perceived first aid as important and were willing to undergo training, respectively; however, only 69% were willing to give first aid. Only 181(52.5%) had ever attended to accident victims. CONCLUSION: Majority of taxi operators had poor first aid knowledge. Factors associated with good knowledge included level of education, number of accidents witnessed, having first aid kits. Although their attitudes were favorable, practice was poor. Comprehensive training and refresher courses can help increase first aid knowledge, and improving practice.

Assessment of the Knowledge and Attitude Towards Dementia Among Undergraduate University Students in Uganda.

BACKGROUND: Dementia remains a public health concern and a leading cause of disability and dependency among older people worldwide. However, the knowledge and attitudes towards dementia among university students remain unknown. This study assessed the knowledge and attitude towards dementia among university students in Uganda. METHODS: An online descriptive, cross-sectional study was undertaken from August to November 2020, among undergraduate students from 11 Ugandan universities. A validated study questionnaire was used to collect data on socio-demographic characteristics, knowledge, and attitudes of dementia. A score <60% was considered poor knowledge while ≥80% good knowledge and more than 80% reflected positive attitudes. RESULTS: Overall, 1005 participants with a median age of 23 (interquartile range: 18 to 35) years participated in the study. The majority of the students were male (56.5%, n=568) and nearly half were pursuing human sciences/medicine-related programs. The mean knowledge score was 65.5% (SD±18.5). Thirty-two percent of the study participants had poor knowledge and only 26.8% (n=269) had good knowledge of dementia. More than half of the study participants believed that dementia is a normal part of aging and that memory loss happens to all people as they age. Attitudes towards patients with dementia were positive with a mean score of 81.9% (SD±19.6) and 65.2% of the study participants had positive dementia attitudes. Those aged more than 24 years were significantly associated with positive attitudes (adjusted odds ratio (AOR): 1.5, 95% CI: 1.1-2.0, p=0.019). There was a weak correlation between knowledge and attitude scores (ρ=0.341, p<0.001). CONCLUSION: Whereas the majority of university students have positive attitudes towards patients with dementia, a significant number still have poor knowledge of the same. Continuous health education is suggested to improve knowledge of dementia in this population. Further studies to understand the perception in the general population are recommended.

Estimation of the burden of tinea capitis among children in Africa.

Tinea capitis is a common and endemic dermatophytosis among school age children in Africa. However, the true burden of the disease is unknown in Africa. We aimed to estimate the burden of tinea capitis among children <18 years of age in Africa. A systematic review was performed using Embase, MEDLINE and the Cochrane Library of Systematic Reviews to identify articles on tinea capitis among children in Africa published between January 1990 and October 2020. The United Nation's Population data (2019) were used to identify the number of children at risk of tinea capitis in each African country. Using the pooled prevalence, the country-specific and total burden of tinea capitis was calculated. Forty studies involving a total of 229,086 children from 17/54 African countries were identified and included in the analysis. The pooled prevalence of tinea capitis was 23% (95% CI, 17%-29%) mostly caused by Trichophyton species. With a population of 600 million (46%) children, the total number of cases of tinea capitis in Africa was estimated at 138.1 (95% CI, 102.0-174.1) million cases. Over 96% (132.6 million) cases occur in sub-Saharan Africa alone. Nigeria and Ethiopia with the highest population of children contributed 16.4% (n = 98.7 million) and 8.5% (n = 52.2 million) of cases, respectively. Majority of the participants were primary school children with a mean age of 10 years. Cases are mostly diagnosed clinically. There was a large discrepancy between the clinical and mycological diagnosis. About one in every five children in Africa has tinea capitis making it one of the most common childhood conditions in the region. A precise quantification of the burden of this neglected tropical disease is required to inform clinical and public health intervention strategies.