Distribution and antifungal susceptibility profile of oropharyngeal Candida species isolated from people living with HIV in the era of universal test and treat policy in Uganda.

Background: Despite the increased frequency of oropharyngeal candidiasis among people living with human immunodeficiency virus (HIV), its management is no longer effective due to empirical treatment and emergence of antifungal resistance (AFR). This study sought to investigate the prevalence of oropharyngeal candidiasis and assess the antifungal susceptibility profile of oropharyngeal Candida species isolated from people living with human immunodeficiency virus. Additionally, we evaluated the correlation between oropharyngeal candidiasis and CD4 T cell as well as viral load counts. Methods: A descriptive cross-sectional study was carried out from April to October 2023 in which 384 people living with HIV underwent clinical examination for oral lesions. Oropharyngeal swabs were collected and cultured on Sabouraud Dextrose agar to isolate Candida species which were identified using the matrix assisted laser desorption ionization time of flight mass spectrometry. Additionally, the antifungal susceptibility profile of Candida isolates to six antifungal drugs was determined using VITEK® (Marcy-l'Étoile, France) compact system. Data on viral load were retrieved from records, and CD4 T cell count test was performed using Becton Dickinson Biosciences fluorescent antibody cell sorter presto. Results: The prevalence of oropharyngeal candidiasis was 7.6%. Oropharyngeal candidiasis was significantly associated with low CD4 T cell count and high viral load. A total of 35 isolates were obtained out of which Candida albicans comprised of 20 (57.1%) while C. tropicalis and C. glabrata comprised 4 (11.4%) each. C. parapsilosis, C. dubliniensis and C. krusei accounted for 2 (5.7%) each. Additionally, 7 (20%) isolates were resistant to fluconazole, 1 (2.9%) to flucytocine and 0.2 (5.7%) isolates were intermediate to caspofungin. However, specific specie isolates like C. albicans showed 20% (4/20), C. glabrata 50% (2/4) and C. krusei 50% (1/2) resistance to fluconazole. Additionally, C. krusei showed 50% resistance to flucytosine. Conclusion: The prevalence of oropharyngeal candidiasis (OPC) among people living with HIV was low, and there was a significant association between OPC and CD4 T cell count as well as viral load. C. albicans was the most frequently isolated oropharyngeal Candida species. C. glabrata and C. krusei exhibited the highest AFR among the non-albicans Candida species. The highest resistance was demonstrated to fluconazole.

In Vitro Evaluation of the Virulence Attributes of Oropharyngeal Candida Species Isolated from People Living with Human Immunodeficiency Virus with Oropharyngeal Candidiasis on Antiretroviral Therapy.

Background: Oropharyngeal Candida species are part commensal microflora in the the oral cavity of health individuals. Commensal Candida species can become opportunist and transition to pathogenic causes of oropharyngeal candidiasis (OPC) in individuals with impaired immunity through ecological cues and expression of virulence factors. Limited studies have evaluated virulence attributes of oropharyngeal Candida species among people living with human immunodeficiency virus (PLHIV) with OPC on antiretroviral therapy (ART) in Uganda. Objective: Evaluation of the Virulence Attributes of Oropharyngeal Candida Species Isolated from People Living with Human Immunodeficiency Virus with Oropharyngeal Candidiasis on Antiretroviral Therapy. Methods: Thirty-five (35) Candida isolates from PLHIV with OPC on ART were retrieved from sample repository and evaluated for phospholipase activity using the egg yolk agar method, proteinase activity using the bovine serum albumin agar method, hemolysin activity using the blood agar plate method, esterase activity using the Tween 80 opacity test medium method, coagulase activity using the classical tube method and biofilm formation using the microtiter plate assay method in vitro. Results: Phospholipase and proteinase activities were detected in 33/35 (94.3%) and 31/35 (88.6%) of the strains, respectively. Up to 25/35 (71.4%) of the strains exhibited biofilm formation while esterase activity was demonstrated in 23/35 (65.7%) of the strains. Fewer isolates 21/35 (60%) of the strains produced hemolysin and coagulase production was the least virulence activity detected in 18/35 (51.4%). Conclusion: Phospholipase and proteinase activities were the strongest virulence attributes of oropharyngeal Candida species.

High prevalence of malaria in pregnancy among women attending antenatal care at a large referral hospital in northwestern Uganda: A cross-sectional study.

BACKGROUND: Malaria in pregnancy contributes to substantial morbidity and mortality among women in Uganda. However, there is limited information on the prevalence and factors associated with malaria in pregnancy among women in Arua district, northwestern Uganda. We, therefore, assessed the prevalence and factors associated with malaria in pregnancy among women attending routine antenatal care (ANC) clinics at Arua regional referral hospital in north-western Uganda. METHODS: We conducted an analytic cross-sectional study between October and December 2021. We used a paper-based structured questionnaire to collect data on maternal socio-demographic and obstetric factors and malaria preventive measures. Malaria in pregnancy was defined as a positive rapid malarial antigen test during ANC visits. We performed a modified Poisson regression analysis with robust standard errors to determine factors independently associated with malaria in pregnancy, reported as adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). RESULTS: We studied 238 pregnant women with a mean age of 25.32±5.79 years that attended the ANC clinic, all without symptomatic malaria. Of the participants, 173 (72.7%) were in their second or third trimester, 117 (49.2%) were first or second-time pregnant women, and 212 (89.1%) reported sleeping under insecticide-treated bednets (ITNs) every day. The prevalence of malaria in pregnancy was 26.1% (62/238) by rapid diagnostic testing (RDT), with the independently associated factors being daily use of insecticide-treated bednets (aPR 0.41, 95% CI 0.28, 0.62), first ANC visit after 12 weeks of gestation (aPR1.78, 95% CI 1.05, 3.03), and being in the second or third trimester (aPR 0.45, 95% CI 0.26, 0.76). CONCLUSION: The prevalence of malaria in pregnancy among women attending ANC in this setting is high. We recommend the provision of insecticide-treated bednets to all pregnant women and early ANC attendance to enable access to malaria preventive therapy and related interventions.

Effect of four or more antenatal care visits on facility delivery and early postnatal care services utilization in Uganda: a propensity score matched analysis.

INTRODUCTION: Maternal mortality remains a global public health issue, more predominantly in developing countries, and is associated with poor maternal health services utilization. Antenatal care (ANC) visits are positively associated with facility delivery and postnatal care (PNC) utilization. However, ANC in itself may not lead to such association but due to differences that exist among users (women). The purpose of this study, therefore, is to examine the effect of four or more ANC visits on facility delivery and early PNC and also the effect of facility-based delivery on early PNC using Propensity Score Matched Analysis (PSMA). METHODS: The present study utilized the 2016 Uganda Demographic and Health Survey (UDHS) dataset. Women aged 15 - 49 years who had given birth three years preceding the survey were considered for this study. Propensity score-matched analysis was used to analyze the effect of four or more ANC visits on facility delivery and early PNC and also the effect of facility-based delivery on early PNC. RESULTS: The results revealed a significant and positive effect of four or more ANC visits on facility delivery [ATT (Average Treatment Effect of the Treated) = 0.118, 95% CI: 0.063 - 0.173] and early PNC [ATT = 0.099, 95% CI: 0.076 - 0.121]. It also found a positive and significant effect of facility-based delivery on early PNC [ATT = 0.518, 95% CI: 0.489 - 0.547]. CONCLUSION: Policies geared towards the provision of four or more ANC visits are an effective intervention towards improved facility-based delivery and early PNC utilisation in Uganda.

Application of a modified Poisson model in identifying factors associated with prevalence of pregnancy termination among women aged 15 - 49 years in Uganda.

Background: Abortion in Uganda is illegal, only permitted when it places the pregnant mother at risk. This study aimed to apply the modified Poisson model in identifying factors associated with the prevalence of pregnancy termination among women of reproductive age in Uganda. Methods: The 2016 Uganda Demographic Health Survey (UDHS) data were used in this study. More than 18,000 women of the age of 15 - 49 years participated in this study. A modified Poisson model that incorporated sampling weights was used to establish the factors associated with pregnancy termination. Results: In Uganda, 18,506 (18.1%) had ever had a pregnancy terminated. The results revealed that, the woman's age [APR = 3.15, 95% CI: 2.72-3.63], being married [APR = 1.55, 95% CI: 1.40-1.71], mass media exposure [APR = 1.18, 95% CI: 1.08-1.29], working status [APR = 1.21, 95% CI: 1.09-1.35], and having visited a health facility [APR = 1.20, 95% CI: 1.10-1.31] were positively significantly associated with likelihood of pregnancy termination. Conclusion: There exists a significant proportion of women who have had their pregnancies terminated in Uganda. It is observed that woman's age, marital status, mass media exposure, having visited a health facility in the last 12 months and working status were main predictors. Based on these results, researchers concluded that the emphasis should be put on improving access to post-abortion care, contraceptive use and media exposure.

Application of a modified Poisson model in identifying factors associated with prevalence of pregnancy termination among women aged 15 ­ 49 years in Uganda

Background: Abortion in Uganda is illegal, only permitted when it places the pregnant mother at risk. This study aimed to apply the modified Poisson model in identifying factors associated with the prevalence of pregnancy termination among women of reproductive age in Uganda. Methods: The 2016 Uganda Demographic Health Survey (UDHS) data were used in this study. More than 18,000 women of the age of 15 ­ 49 years participated in this study. A modified Poisson model that incorporated sampling weights was used to establish the factors associated with pregnancy termination. Results: In Uganda, 18,506 (18.1%) had ever had a pregnancy terminated. The results revealed that, the woman's age [APR = 3.15, 95% CI: 2.72-3.63], being married [APR = 1.55, 95% CI: 1.40-1.71], mass media exposure [APR = 1.18, 95% CI: 1.08-1.29], working status [APR = 1.21, 95% CI: 1.09-1.35], and having visited a health facility [APR = 1.20, 95% CI: 1.10-1.31] were positively significantly associated with likelihood of pregnancy termination. Conclusion: There exists a significant proportion of women who have had their pregnancies terminated in Uganda. It is observed that woman's age, marital status, mass media exposure, having visited a health facility in the last 12 months and working status were main predictors. Based on these results, researchers concluded that the emphasis should be put on improving access to post-abortion care, contraceptive use and media exposure