Chemical contaminant exposures assessed using silicone wristbands among fuel station attendants, taxi drivers and commercial motorcycle riders in Kampala, Uganda.

There are concerns over traffic-related air pollution in Uganda's capital, Kampala. Individuals in the transportation sector are hypothesized to be at greater risk for exposure to volatile organic compounds, given their proximity to vehicle exhaust. Silicone wristbands are a wearable technology that passively sample individuals' chemical exposures. We conducted a pilot cross sectional study to measure personal exposures to volatile organic compounds among 14 transportation workers who wore a wristband for five days. We analyzed for 75 volatile organic compounds; 33 chemicals (35%) were detected and quantified in at least 50% of the samples and 15 (16%) chemicals were detected and quantified across all the samples. Specific chemicals were associated with participants' occupation. The findings can guide future large studies to inform policy and practice to reduce exposure to chemicals in the environment in Kampala.

Capacity of enforcers and level of enforcement of the Tobacco Control Act 2015 in Kampala, Uganda.

Tobacco use is a leading cause of preventable deaths worldwide. Uganda enacted the Tobacco Control Act (TCA) 2015 to domesticate implementation of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) regulations. This study assessed the capacity to enforce the TCA and associated factors, as well as the level and barriers to its enforcement in Kampala, Uganda. A cross-sectional study using both quantitative and qualitative methods was employed. A structured questionnaire was used for quantitative data collection, and a WHO adapted capacity assessment open-ended guide was used for key informant interviews. Multivariable logistic regression was used to obtain odds ratios and 95% confidence intervals for the independent predictors for capacity to enforce the TCA. A total of 162 respondents from 5 institutions and six key informants were involved in the study. Findings established that only 23% (37/162) of the enforcers had the capacity to enforce the TCA. Male enforcers [OR = 0.16, 95% CI (0.05-0.55)], those who did not know when the law was enacted [OR = 0.19, 95% CI (0.07-0.52)], those with no plans to enforce the law [OR = 0.22, 95% CI (0.05-0.93)], and older enforcers (aged 31-40 years) [OR = 0.27, 95% CI (0.09-0.81)] were less likely to have the capacity to enforce the TCA. The level of enforcement of the TCA was mainly low to moderate for most of the institutions mandated to enforce it. Lack of knowledge about the law amongst the enforcers and general public, and inadequate funds were reported as major barriers to enforcement of the TCA. The capacity to enforce the TCA in Kampala was low. There is potential to enhance the capacity of enforcers through further dissemination of the Act, as well as sensitization of enforcers, institutional managers, and the general public about the legislation.

Indoor air pollutants and respiratory symptoms among residents of an informal urban settlement in Uganda: A cross-sectional study.

BACKGROUND: Indoor air pollutants (IAP) and household conditions such as dampness, crowding and chemical exposures have been associated with acute and chronic respiratory infections. In Uganda, literature on the effects of IAP on respiratory outcomes in informal settlements is limited. METHODS: We describe the baseline household characteristics of 284 adults and their children in an informal settlement in Uganda from April to May 2022. We monitored same-day indoor concentrations of particulate matter PM2.5, PM10, Carbon monoxide (CO), relative humidity %, and temperature from 9 am to 2 pm and interviewed caregivers/mothers about their respiratory symptoms and those of their children in the previous 30 days. We employed robust Poisson regressions to evaluate the associations between indoor air indicators and respiratory health symptoms. RESULTS: Approximately 94.7% of households primarily used biomass fuels and 32.7% cooked from inside their dwelling rooms. The median PM2.5, PM10 and CO levels were 49.5 (Interquartile range (IQR) = 31.1,86.2) µg/m3, 73.6 (IQR = 47.3,130.5) µg/m3 and 7.70 (IQR = 4.1,12.5) ppm respectively. Among adults, a 10 unit increase in PM2.5 was associated with cough (Prevalence Ratio (PR) = 3.75, 95%CI 1.15-1.55). Dwelling unit dampness was associated with phlegm (PR = 2.53, 95%CI = 1.39-4.61) and shortness of breath (PR = 1.78, 95% CI 1.23-2.54) while cooking from outside the house was protective against shortness of breath (PR = 0.62, 95% CI = 0.44-0.87). In children, dampness was associated with phlegm (PR = 13.87, 95% CI 3.16-60.91) and cough (PR = 1.62, 95% CI 1.12-2.34) while indoor residual spraying was associated with phlegm (PR = 3.36, 95%CI 1.71-6.61). CONCLUSION: Poor indoor air conditions were associated with respiratory symptoms in adults and children. Efforts to address indoor air pollution should be made to protect adults and children from adverse health effects.

Consumer Awareness and Health Risk Perceptions of Pesticide Residues in Fruits and Vegetables in Kampala Metropolitan Area in Uganda.

Consumer awareness of the presence of pesticides in fruits and vegetables and associated health risks influences the actions they undertake to reduce their exposure. This study was carried out to explore consumers' awareness of pesticide residues in fruits and vegetables and perceptions towards associated health effects in Kampala Metropolitan Area (KMA) in Uganda. Eight focus group discussions (FGDs) were done with fruit and vegetables consumers in KMA. The FGDs consisted of females and males living in urban and rural areas. Discussions were recorded and transcribed. The transcripts were coded inductively and analysed using conventional content analysis. Consumers were aware of the presence of pesticide residues in fruits and vegetables. Non-compliance to good agricultural practices, desire to produce good quality fruits and vegetables, and conflict of interest were thought to be the underlying reasons for the contamination. Consumers thought that their health is at risk of chronic and acute health effects, and that this risk is unavoidable. They emphasized that long term exposure to the pesticide residues puts them at risk of conditions like reproductive defects and noncommunicable diseases like cancer, hypertension, obesity, kidney and heart diseases among others. To reduce the risk, consumers were aware of and relied on mitigation measures including washing, peeling, drying and cooking or applied them in combination. Consumers were aware of the presence of pesticide residues on fruits and vegetables, potential short and long term health risks due to exposure, and domestic processing methods to reduce health risks. There is need for authorities to ensure adherence to good agricultural practices and ensure that farmers and consumers understand that pesticide are used to control pests and disease but not to primarily increase shelf life of fruits and vegetables.

Antimicrobial resistance among farming communities in Wakiso District, Central Uganda: A knowledge, awareness and practice study.

BACKGROUND: Antibiotics are increasingly becoming ineffective as antimicrobial resistance (AMR) continues to develop and spread globally-leading to more difficult to treat infections. Countries such as Uganda are still challenged with implementation of AMR related strategies due to data paucity. This includes a lack of data on the prevailing knowledge and awareness of antimicrobial resistance and antibiotic use among farming communities, both commercial and subsistence, which are instrumental in the implementation of targeted interventions. The aim of our study was to assess the knowledge, attitudes and practices on AMR among subsistence and commercial farmers in Wakiso district, central Uganda. METHODS: A cross-sectional study was conducted using a semi-structured questionnaire in Wakiso district, Central Uganda in between June and September 2021. Polytomous latent class analyses were performed to group participants based on their responses. Multivariable regression and conditional inference trees were used to determine the association between demographic factors and knowledge on antibiotics and AMR. RESULTS: A total of 652 respondents participated in the study among whom 84% were able to correctly describe what antibiotics are. Subsistence farmers (OR = 6.89, 95% CI [3.20; 14.83]), and to a lesser extent, farming community members which obtained their main income by another business (OR = 2.25, 95% CI [1.345; 3.75]) were more likely to be able to describe antibiotics correctly than individuals involved in commercial farming. Based on the latent class analysis, three latent classes indicating different levels of knowledge on AMR, were found. Subsistence farming, higher educational level and younger age were found to be associated with belonging to a class of better knowledge. CONCLUSION: The majority of participants were able to correctly describe antibiotics and aware of AMR, however there was some degree of misunderstanding of several AMR concepts. Targeted AMR interventions should improve awareness and also ensure that not only subsistence farmers, but commercial farmers, are included.

Epidemiology of extended-spectrum beta-lactamase-producing Escherichia coli at the human-animal-environment interface in a farming community of central Uganda.

BACKGROUND: Extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-Ec) represents a significant global public health concern. The epidemiology of ESBL-Ec in Uganda is not well understood although it is harbored by humans, animals, and the environment. This study explains the epidemiology of ESBL-Ec using a one health approach in selected farming households in Wakiso district, Uganda. METHODOLOGY: Environmental, human, and animal samples were collected from 104 households. Additional data were obtained using observation checklists and through interviews with household members using a semi-structured questionnaire. Surface swabs, soil, water, human and animal fecal samples were introduced onto ESBL chromogenic agar. The isolates were identified using biochemical tests and double-disk synergy tests. To assess associations, prevalence ratios (PRs) were computed using a generalized linear model (GLM) analysis with modified Poisson and a log link with robust standard errors in R software. RESULTS: Approximately 83% (86/104) households had at least one positive ESBL-Ec isolate. The overall prevalence of ESBL-Ec at the human-animal-environment interface was approximately 25.0% (95% CI: 22.7-28.3). Specifically, humans, animals and the environment had an ESBL-Ec prevalence of 35.4%, 55.4%, and 9.2% respectively. Having visitors (adj PR = 1.19, 95% CI: 1.04-1.36), utilizing veterinary services (adj PR = 1.39, 95% CI: 1.20-1.61) and using animal waste for gardening (adj PR = 1.29, 95% CI: 1.05-1.60) were positively associated with household ESBL-Ec contamination. Covering the drinking water container with a lid (adj PR = 0.84 95% CI: 0.73-0.96) was associated with absence of ESBL-Ec in a household. CONCLUSION: There is wider dissemination of ESBL-Ec in the environment, humans, and animals, indicating poor infection prevention and control (IPC) measures in the area. Improved collaborative one health mitigation strategies such as safe water chain, farm biosecurity, household and facility-based IPC measures are recommended to reduce the burden of antimicrobial resistance at community level.

Association between recent COVID-19 diagnosis, depression and anxiety symptoms among slum residents in Kampala, Uganda.

BACKGROUND: Despite the known link between poor living conditions and mental health, there has been little research on the mental health of slum dwellers worldwide. Although the Coronavirus disease 2019 (COVID-19) pandemic has led to an increase in mental health issues, little focus has been given to the impact on slum dwellers. The study aimed to investigate the association between recent COVID-19 diagnosis and the risk of depression and anxiety symptoms among people living in an urban slum in Uganda. METHODS: A cross-sectional study was conducted among 284 adults (at least 18 years of age) in a slum settlement in Kampala, Uganda between April and May 2022. We assessed depression symptoms and anxiety using validated Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder assessment tool (GAD-7) questionnaires respectively. We collected data on sociodemographic characteristics, and self-reported recent COVID-19 diagnosis (in the previous 30 days). Using a modified Poisson regression, adjusted for age, sex, gender and household income, we separately provided prevalence ratios and 95% confidence intervals for the associations between recent COVID-19 diagnosis and depressive and anxiety symptoms. RESULTS: Overall, 33.8% and 13.4% of the participants met the depression and generalized anxiety screening criteria respectively and 11.3% were reportedly diagnosed with COVID-19 in the previous 30 days. People with recent COVID-19 diagnosis were more likely to be depressed (53.1%) than those with no recent diagnosis (31.4%) (p<0.001). Participants who were recently diagnosed with COVID-19 reported higher prevalence of anxiety (34.4%) compared to those with no recent diagnosis of COVID-19 (10.7%) (p = 0.014). After adjusting for confounding, recent diagnosis with COVID-19 was associated with depression (PR = 1.60, 95% CI 1.09-2.34) and anxiety (PR = 2.83, 95% CI 1.50-5.31). CONCLUSION: This study suggests an increased risk of depressive symptoms and GAD in adults following a COVID-19 diagnosis. We recommend additional mental health support for recently diagnosed persons. The long-term of COVID-19 on mental health effects also need to be investigated.

Phenotypic Characterization and Antibiograms of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli Isolated at the Human-Animal-Environment Interface Using a One Health Approach Among Households in Wakiso District, Uganda.

Background: The occurrence of extended spectrum beta-lactamase (ESBL) producing bacteria such as Escherichia coli has increasingly become recognized beyond hospital settings. Resistance to other types of antibiotics limits treatment options while the existence of such bacteria among humans, animals, and the environment is suggestive of potential zoonotic and reverse-zoonotic transmission. This study aimed to establish the antibiotic susceptibility profiles of the ESBL-producing Escherichia coli (ESBL-EC) from human, animal, and environmental isolates obtained among farming households within Wakiso district using a One Health approach. Methods: A total of 100 ESBL-EC isolates from humans 35/100 (35%), animals 56/100 (56%), and the environment 9/100 (9%) were tested for susceptibility to 11 antibiotics. This was done using the Kirby-Bauer disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Data were analyzed in STATA ver. 16 and graphs were drawn in Microsoft excel ver. 10. Results: Most of the ESBL-EC isolates (98%) were resistant to more than two antibiotics. ESBL-EC isolates were most susceptible to meropenem (MEM) (88.0%), and imipenem (82.0%) followed by gentamicin (72%). ESBL-EC isolates from humans were most susceptible to meropenem (MEM) followed by imipenem (IPM)> gentamicin (CN)> ciprofloxacin (CIP). Animal samples were more susceptible to MEM, IPM, and CN but were highly resistant to cefotaxime (CTX)> cefepime (FEP)>other antibiotics. Multidrug resistance (MDR) was mostly reported among households keeping goats under intensive husbandry practices. Seven percent of the isolates exhibited carbapenem resistance while 22% showed aminoglycoside resistance. Similar resistance patterns among humans, animals, and environmental samples were also reported. Conclusion: Our study provides baseline information on non-hospital-based MDR caused by ESBL-EC using a One Health approach. ESBL-EC isolates were prevalent among apparently healthy community members, animals, and their environment. It is important to conduct more One Health approach studies to generate evidence on the drivers, resistance patterns, and transmission of ESBL-producing organisms at the human-animal-environmental interface.

Social media use and alcohol consumption among students in Uganda: a cross sectional study.

BACKGROUND: Globally, alcohol use significantly contributes to the disease burden. Alcohol consumption in Uganda is related to several health consequences among young people, including university students. Social media is commonly used by students to share academic information and create social networks. Among young people in high-income countries, previous studies have also shown that social media use can have negative health outcomes related to alcohol use, and associated problems. To date, similar studies conducted in low- and middle-income countries are largely missing. OBJECTIVE: To assess the prevalence of and associations between social media use and alcohol consumption among university students in Uganda. METHOD: This was a cross-sectional study among 996 undergraduate students at Makerere University. Data were collected using a questionnaire. Alcohol use in the previous 12 months was the dependent variable. The independent variable was social media use categorised as general use, alcohol-related use, and social media lurking/passive participation. Multinomial logistic regression was used to assess associations. Crude and adjusted odds ratios were reported. RESULTS: Nearly all students (97%) used social media and 39% reported alcohol use. Regular alcohol use was significantly associated with moderate (OR = 2.22, CI: 1.35-3.66) and high level general social media use (OR = 2.45, CI: 1.43-4.20). Regular alcohol use was also associated with alcohol-related social media (OR = 6.46, CI: 4.04-10.30), and alcohol-related lurking (OR = 4.59, CI: 2.84-7.39). Similar, although weaker associations were identified for occasional alcohol use. CONCLUSIONS: Approximately four in ten students reported alcohol use in the past year, and almost all students used social media. Alcohol-related social media use was associated with occasional and regular alcohol use, with stronger associations for regular use. These findings may guide further research and present an opportunity for potential alcohol control interventions to improve health among young populations in low- and middle-income countries.

Use of biomass fuels predicts indoor particulate matter and carbon monoxide concentrations; evidence from an informal urban settlement in Fort Portal city, Uganda.

BACKGROUND: Poor indoor air quality (IAQ) is a leading cause of respiratory and cardiopulmonary illnesses. Particulate matter (PM2.5) and carbon monoxide (CO) are critical indicators of IAQ, yet there is limited evidence of their concentrations in informal urban settlements in low-income countries. OBJECTIVE: This study assessed household characteristics that predict the concentrations of PM2.5 and CO within households in an informal settlement in Fort Portal City, Uganda. METHODOLOGY: A cross-sectional study was conducted in 374 households. Concentrations of PM2.5 and CO were measured using a multi-purpose laser particle detector and a carbon monoxide IAQ meter, respectively. Data on household characteristics were collected using a structured questionnaire and an observational checklist. Data were analysed using STATA version 14.0. Linear regression was used to establish the relationship between PM2.5, CO concentrations and household cooking characteristics. RESULTS: The majority (89%, 332/374) of the households used charcoal for cooking. More than half (52%, 194/374) cooked outdoors. Cooking areas had significantly higher PM2.5 and CO concentrations (t = 18.14, p ≤ 0.05) and (t = 5.77 p ≤ 0.05), respectively. Cooking outdoors was associated with a 0.112 increase in the PM2.5 concentrations in the cooking area (0.112 [95% CI: -0.069, 1.614; p = 0.033]). Cooking with moderately polluting fuel was associated with a 0.718 increase in CO concentrations (0.718 [95% CI: 0.084, 1.352; p = 0.027]) in the living area. CONCLUSIONS: The cooking and the living areas had high concentrations of PM2.5 and CO during the cooking time. Cooking with charcoal resulted in higher CO in the living area. Furthermore, cooking outdoors did not have a protective effect against PM2.5, and ambient PM2.5 exceeded the WHO Air quality limits. Interventions to improve the indoor air quality in informal settlements should promote a switch to cleaner cooking energy and improvement in the ambient air quality.

Factors Associated With Utilization of Ecological Sanitation Technology in Burera District, Rwanda: A Mixed Methods Research.

Background: The utilization of "on-site excreta decomposition technology" known as "Ecological sanitation (Ecosan)" has a rational use of human excreta. It is a resource-oriented sanitation mostly feasible in areas with rocky soil and prone to agriculture. This technology was implemented in Rwanda for more than a decade. However, little is known about Ecosan utilization in the process of scale-up in the community. Aim: The study was carried out to determine enablers and barriers associated with the utilization of Ecosan in Burera district, Rwanda. Methods: A mixed method study was surveyed in 374 households with Ecosan. A systematic random sampling was used to select respondents and a sample was drawn from the 3 administrative sectors of Burera district. We interviewed 20 key informants that included community leaders and sanitation actors. Bivariate, ordered logistic regression with thematic content analysis were used. Results: Ecosan users were unable to practice both urine diversion and the use of Ecosan by-products. Only 39.4% of households were better users. As by the survey results, primary and secondary educational status (AOR 2.60, 95% CI 1.11-6.08) and (AOR 3.49, 95% CI 1.02-11.9), frequency of fecal pit emptying (AOR 3.38, 95% CI (2.18-17.91), ash use (AOR 1.65, 95% CI (0.93-4.64) and concrete slab latrine (AOR 7.31, 95% CI (2.94-17.95) were found to be associated with better use of Ecosan. Qualitative findings suggested unaffordable cost, a touch of excreta taboos, and poor maintenance practices as key barriers to utilization. Conclusion: Overall utilization of Ecosan was poor and the majority of households was not able to use Ecosan for both dry separation of urine from feces and reuse in the gardens. Upgrading existing knowledge about Ecosan with greater emphasis on the use of by-products and adopting good maintenance practices through regular training can promote better utilization of Ecosan.

Pesticide Residues in Fresh Fruit and Vegetables from Farm to Fork in the Kampala Metropolitan Area, Uganda.

This study assessed concentrations of pesticide residues in fruits and vegetables from farm-to-fork in Kampala Metropolitan Area, Uganda. A total of 160 samples of fruit and vegetables collected from farms, markets, streets, restaurants and homes were analysed using liquid chromatography-tandem mass spectrometry; and Gas Chromatograph-Mass Spectrometer for dithiocarbamates. Multiple pesticide residues were detected in majority of the samples (95.6%). The proportions of the most frequently detected pesticides residue classes were organophosphates (91.3%), carbamates (67.5%), pyrethroids (60.0%) dithiocarbamates (48.1%) and neonicotinoids (42.5%). Among organophosphates, propotamophos, acephate, fonofos, monocrotophos and dichlorvos were the most detected active ingredients; aminocarb, methomyl and pirimicarb were the commonly detected carbamates; while imidacloprid, a neonicotinoid and lambda-cyhalothrin, pyrethroid were also highly detected. Twenty-seven pesticide were tested at all stages, of which the concentrations either decreased or increased along the chain. Multiple pesticide residues occurred in commonly consumed fruit and vegetables with decreasing or increasing concentrations from farm-to-fork.

An assessment of health risks posed by consumption of pesticide residues in fruits and vegetables among residents in the Kampala Metropolitan Area in Uganda.

Background: Pesticide use for fruits and vegetable production in Uganda may result in presence of residues on produce which may pose health risks to consumers. Uganda does not have an established system for monitoring pesticide residues in fruits and vegetables and assessing potential health risks. This research aimed to conduct a health risk assessment of presence of pesticide residues in fruits and vegetables in the Kampala Metropolitan Area in Uganda. Method: Pesticides were measured in 160 fruits and vegetables samples collected at farms, markets, street vendors, restaurants and homes; and analysed using liquid chromatography-tandem mass spectrometry and gas chromatography-mass spectrometry. Fruit and vegetable consumption information was collected from 2177 people. Pesticide concentrations were compared with European Union maximum residual limits (MRLs). Mean values of pesticide concentration residues found in the sample of fruits and vegetables; and fruits and vegetables intake and body weight were used to calculate the estimated daily intake (EDI) of pesticide residues. EDI values were compared with acceptable daily intakes (ADI) to calculate the hazard quotient by age group, and stage at which consumption happens along the chain. Results: Overall, 57 pesticides were detected in fruits and vegetables from farm to fork. Of the 57, 39 pesticides were detected in all the fruits and vegetables studied. Concentrations of fonofos, fenitrothion and fenhexamid were above the European Union MRLs in some samples. Hazard quotients based on dietary ingestion scenarios for 18 pesticides, including dichlorvos (444) alanycarb (314), fonofos (68), fenitrothion (62), dioxacarb (55) and benfuracarb (24) and others, were above 1, indicating the possibility of chronic health risk to consumers. Chronic health risk decreased with age but was stable for stage at which consumption happens along the food chain. The number of pesticides with EDI greater than the ADI decreased with increase in age; with 18, 13, 9, 11, 8, 9, and 9 pesticides for age groups < 5, 5-12, 13-19, 20-25, 36-49 and ≥ 50 respectively. Conclusion: Chronic dietary pesticide exposures to Ugandans are likely common, and for some pesticides result in exposure exceeding health-based benchmarks. Risks were highest for younger participants. There is an urgent need to increase monitoring and regulation of pesticides in fruits and vegetables in order to protect consumers, especially the children who are vulnerable to the adverse effects of pesticides. Supplementary Information: The online version contains supplementary material available at 10.1186/s40550-022-00090-9.

Contextual and psychological factors influencing open defecation free status: an exploratory qualitative study in rural South Western Uganda.

INTRODUCTION: Achieving the Open defecation free (ODF) status remains a major challenge in Uganda, yet it contributes significantly to child health improvement. Literature on social, cultural and behavioral aspects that influence the ODF status in rural Uganda is limited. The study therefore, explored perceived factors influencing the ODF status in rural South Western Uganda. METHODS: An exploratory study employing qualitative techniques and based on deductive analysis between month December 2020 and January 2021 was conducted. Seven Focus Group Discussions (FGDs and three Key Informant Interviews (KIs) were conducted in Kabale District, southwestern Uganda. Focus Group Discussion participants were mothers and fathers having children of 2 years and below while KIIs included local community leaders and health extension workers. Data was analyzed using a categorization matrix derived from the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) model which is comprised of contextual and psychological factors. Text was further categorized into high and low statements for attainment of ODF status. RESULTS: The contextual factors influencing the Open Defecation Free status behavior included; farming activities far from home, financial constraints, rainy seasons, collapsible soft soils, and alcohol use. Psychological factors influencing ODF status included; perceived health risk for typhoid disease, low perceived severity for lack of ODF components, negative attitude of less value attached to ODF components, and a feeling of time wastage practicing ODF status behavior. The perception that the community has the ability to attain the ODF status was high. Although, the capability to maintain ODF was low when it comes to replacement of ODF component if stolen or destroyed. CONCLUSION: Open Defecation Free status is influenced by contextual and psychological factors. Therefore, it's crucial for sanitation promotors to always identify such context specific factors in order to design sanitation and hygiene promotion interventions to address the ODF free status related challenges.

Pesticide Residue Trends in Fruits and Vegetables from Farm to Fork in Kampala Metropolitan Area, Uganda-A Mixed Methods Study.

This mixed methods study used laboratory measurements of pesticide residues in produce, semi-structured questionnaires, and in-depth interview data to describe trends in pesticide residue in produce and handling and processing practices for fruits (watermelon and passion fruit) and vegetables (tomato, cabbage, and eggplant) along the farm to fork chain. Of the 50 farmers visited, 34 (68.0%) sold their fruits and vegetables to transporters, 11 (22.0%) to market vendors, and 4 (8.0%) directly to homes and restaurants. The majority 42 (93.3%) of the consumers (home/restaurant) purchased their fruits and vegetables from market vendors and transporters. Washing with water or vinegar, wiping with a cloth, peeling the outer layer, and blending and cooking were the most common post-harvesting processing methods used by stakeholders along the supply chain. Some farmers and market vendors reported spraying fruits and vegetables with pesticides either prior- or post-harvest to increase shelf life. Statistically significant decreasing pesticide residue trends along the farm to fork chain were observed for dioxacarb, likely due to degradation or washing, peeling, cooking, blending, or wiping by consumers. Increasing trends were observed for methidathion and quinalphos possibly due to pesticide applications. There is a need in Uganda to promote practices that minimize pesticide use and exposure through diet, while maintaining food integrity.

Integrated malaria prevention in rural communities in Uganda: a qualitative feasibility study for a randomised controlled trial.

BACKGROUND: A randomised controlled trial (RCT) on integrated malaria prevention, which advocates the use of several malaria prevention methods holistically, has been proposed. However, before conducting an RCT, it is recommended that a feasibility study is carried out to provide information to support the main study, particularly for such a complex intervention. Therefore, a feasibility study for an RCT on integrated malaria prevention in Uganda was conducted. METHODS: The qualitative study carried out in Wakiso District employed focus group discussions (FGDs) and key informant interviews (KIIs) to explore community willingness to participate in the RCT as well as assess stakeholder perspectives on the future study. The participants of the FGDs were community members, while the key informants were selected from malaria stakeholders including Ministry of Health officials, health practitioners, local leaders, district health team members, and community health workers (CHWs). Thematic analysis was employed with the support of NVivo. RESULTS: A total of 12 FGDs and 19 KIIs were conducted. Five main themes emerged from the study: malaria prevention practices related to integrated malaria prevention; preferred malaria prevention methods in the integrated approach; potential challenges of integrated malaria prevention; perspectives on the proposed RCT; and sustainability of integrated malaria prevention. Despite a few methods being employed holistically in the community, insecticide-treated nets were the most widely used and preferred method for malaria prevention mainly because they were provided free by the government. The main challenges in the integrated approach were the high cost of some methods such as house screening, and concerns about the potential side effects of insecticide-based methods such as indoor residual spraying. Participants expressed high willingness to participate in the RCT to promote the use of multiple methods in their households and community. Involvement of CHWs during implementation was proposed as a sustainability strategy for the RCT interventions. CONCLUSION: There was high willingness to participate in the proposed RCT on integrated malaria prevention. However, high cost and perceived negative health effects from some methods were identified as potential challenges. The type of methods to be included as well as sustainability mechanisms needs to be considered during the design of the RCT.

Precision and accuracy of FEV1 measurements from the Vitalograph copd-6 mini-spirometer in a healthy Ugandan population.

OBJECTIVE: Evaluate the accuracy and precision of the copd-6 mini-spirometer for FEV1 in a rural Ugandan population. METHODS: In a cross-sectional study, 171 smallholder farmers performed spirometry with copd-6, and a diagnostic-quality spirometer. RESULTS AND DISCUSSION: The copd-6 underestimated FEV1 at low flows and overestimated FEV1 at high flows. Across all participants, the device slightly overestimated FEV1 by 0.04 [0.02; 0.06] L. Calibration data showed similar patterns. CONCLUSION: The copd-6 could be considered as an affordable tool for research on lung function impairment in resource-constrained settings. However, further validation in a study population with obstructive lung disease is needed.

Factors associated with health facility deliveries among mothers living in hospital catchment areas in Rukungiri and Kanungu districts, Uganda.

BACKGROUND: Health facility deliveries are generally associated with improved maternal and child health outcomes. However, in Uganda, little is known about factors that influence use of health facilities for delivery especially in rural areas. In this study, we assessed the factors associated with health facility deliveries among mothers living within the catchment areas of major health facilities in Rukungiri and Kanungu districts, Uganda. METHODS: Cross-sectional data were collected from 894 randomly-sampled mothers within the catchment of two private hospitals in Rukungiri and Kanungu districts. Data were collected on the place of delivery for the most recent child, mothers' sociodemographic and economic characteristics, and health facility water, sanitation and hygiene (WASH) status. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the determinants of health facility deliveries as well as factors associated with private versus public utilization of health facilities for childbirth. RESULTS: The majority of mothers (90.2%, 806/894) delivered in health facilities. Non-facility deliveries were attributed to faster progression of labour (77.3%, 68/88), lack of transport (31.8%, 28/88), and high cost of hospital delivery (12.5%, 11/88). Being a business-woman [APR = 1.06, 95% CI (1.01-1.11)] and belonging to the highest wealth quintile [APR = 1.09, 95% CI (1.02-1.17)] favoured facility delivery while a higher parity of 3-4 [APR = 0.93, 95% CI (0.88-0.99)] was inversely associated with health facility delivery as compared to parity of 1-2. Factors associated with delivery in a private facility compared to a public facility included availability of highly skilled health workers [APR = 1.15, 95% CI (1.05-1.26)], perceived higher quality of WASH services [APR = 1.11, 95% CI (1.04-1.17)], cost of the delivery [APR = 0.85, 95% CI (0.78-0.92)], and availability of caesarean services [APR = 1.13, 95% CI (1.08-1.19)]. CONCLUSION: Health facility delivery service utilization was high, and associated with engaging in business, belonging to wealthiest quintile and having higher parity. Factors associated with delivery in private facilities included health facility WASH status, cost of services, and availability of skilled workforce and caesarean services.

Organophosphate and carbamate insecticide exposure is related to lung function change among smallholder farmers: a prospective study.

INTRODUCTION AND AIM: Exposure to some insecticides may cause airway obstruction, but existing evidence is limited by cross-sectional designs and inadequate confounder control. We investigated the relation between organophosphate and carbamate insecticides and pulmonary function in a prospective study accounting for important confounders. METHODS: In a cohort of 364 smallholder farmers in Uganda (69% women), participants underwent pre-bronchodilator spirometry at baseline (September/October 2018) and at two follow-up visits (November/December 2018 and January/February 2019). Exposure to carbamate and organophosphate insecticides was assessed using haemoglobin-adjusted erythrocyte acetylcholinesterase (AChE/Hb). Less than 3% of participants were lost to follow-up. We calculated Z-scores for FEV1, FVC and FEV1/FVC using the Global Lung Function Initiative equations. Data were analysed in linear mixed and fixed effect models accounting for family relationships and repeated measures of exposure and outcome. RESULTS: Low AChE/Hb was significantly associated with low FEV1 Z-score in both unadjusted and adjusted analyses. Compared with individuals with AChE/Hb 25.90 U/g (50th percentile, reference), those with lower AChE/Hb 24.50 U/g (35th percentile) had mean FEV1 Z-score 0.045 (0.003 to 0.087) lower, and persons with higher AChE/Hb 27.30 U/g (65th percentile) had a mean FEV1 Z-score 0.043 (-0.002 to 0.087) higher compared with the reference. Similar, but numerically smaller and statistically non-significant effects were seen for Z-scores of FVC and FEV1/FVC. CONCLUSION: Exposure to organophosphate and carbamate insecticides may lead to lung function decline. Our results add to the growing evidence of health effects in relation to exposure to organophosphate and carbamate insecticides, underlining the importance of minimising exposure.

Assessment of water, sanitation and hygiene service availability in healthcare facilities in the greater Kampala metropolitan area, Uganda.

BACKGROUND: Improved Water, Sanitation and Hygiene (WASH) in Healthcare facilities (HCFs) is of significant public health importance. It is associated with a reduction in the transmission of healthcare acquired infections (HAIs), increased trust and uptake of healthcare services, cost saving from infections averted, increased efficiency and improved staff morale. Despite these benefits, there is limited evidence on availability of WASH services in HCFs in the Greater Kampala Metropolitan Area (GKMA). This study assessed the availability and status of WASH services within HCFs in the GKMA in order to inform policy and WASH programming. METHODS: A cross-sectional study was conducted in 60 HCFs. Availability of WASH services in the study HCFs was assessed using a validated WASH Conditions (WASHCon) tool comprising of structured interviews, HCF observations and microbial water quality analysis. Data were analysed using Stata 14 software and R software. RESULTS: Overall, 84.5% (49/58) and 12.1% (7/58) of HCFs had limited and basic WASH service respectively. About 48.3% (28/58) had limited water service, 84.5% (49/58) had limited sanitation service, 50.0% (29/58) had limited environmental cleanliness service, 56.9% (33/58) had limited hand hygiene service, and 51.7% (30/58) had limited waste management service. About 94.4% of public HCFs had limited WASH service compared to only 68.2% of private not for profit facilities. More health centre IIIs, 92.5% and health centre IVs (85.7%) had limited WASH service compared to hospitals (54.5%). CONCLUSIONS: Our findings indicate that provision of water, sanitation, hand hygiene, environmental cleanliness, and health care waste management services within HCFs is largely hindered by structural and performance limitations. In spite of these limitations, it is evident that environmental cleanliness and treatment of infectious waste can be attained with better oversight and dedicated personnel. Attaining universal WASH coverage in HCFs will require deliberate and strategic investments across the different domains.