Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 11.525
Filtrar
1.
Infect Dis Poverty ; 9(1): 12, 2020 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-32114979

RESUMEN

BACKGROUND: Around 2007, a nodding syndrome (NS) epidemic appeared in onchocerciasis-endemic districts of northern Uganda, where ivermectin mass distribution had never been implemented. This study evaluated the effect of community-directed treatment with ivermectin (CDTI) and ground larviciding of rivers initiated after 2009 and 2012 respectively, on the epidemiology of NS and other forms of epilepsy (OFE) in some districts of northern Uganda. METHODS: In 2012, a population-based community survey of NS/epilepsy was carried out by the Ugandan Ministry of Health in Kitgum and Pader districts. In August 2017, we conducted a new survey in selected villages of these districts and compared our findings with the 2012 data. In addition, two villages in Moyo district (where CDTI was ongoing since 1993) served as comparative onchocerciasis-endemic sites in which larviciding had never been implemented. The comparison between 2012 and 2017 prevalence and cumulative incidence were done using the Fisher's and Pearson's Chi-square tests at 95% level of significance. RESULTS: A total of 2138 individuals in 390 households were interviewed. In the selected villages of Kitgum and Pader, there was no significant decrease in prevalence of NS and OFE between 2012 and 2017. However, the cumulative incidence of all forms of epilepsy decreased from 1165 to 130 per 100 000 persons per year (P = 0.002); that of NS decreased from 490 to 43 per 100 000 persons per year (P = 0.037); and for OFE from 675 to 87 per 100 000 persons per year (P = 0.024). The median age of affected persons (NS and OFE) shifted from 13.5 (IQR: 11.0-15.0) years in 2012 to 18.0 (IQR: 15.0-20.3) years in 2017; P <  0.001. The age-standardized prevalence of OFE in Moyo in 2017 was 4.6%, similar to 4.5% in Kitgum and Pader. CONCLUSIONS: Our findings support the growing evidence of a relationship between infection by Onchocerca volvulus and some types of childhood epilepsy, and suggest that a combination of bi-annual mass distribution of ivermectin and ground larviciding of rivers is an effective strategy to prevent NS and OFE in onchocerciasis-hyperendemic areas.


Asunto(s)
Epilepsia/epidemiología , Síndrome del Cabeceo/epidemiología , Oncocercosis/prevención & control , Adolescente , Animales , Antiparasitarios/uso terapéutico , Niño , Enfermedades Endémicas , Epilepsia/parasitología , Femenino , Humanos , Incidencia , Ivermectina/uso terapéutico , Masculino , Síndrome del Cabeceo/parasitología , Onchocerca volvulus , Oncocercosis/complicaciones , Oncocercosis/epidemiología , Prevalencia , Uganda/epidemiología , Adulto Joven
2.
Rev Infirm ; 69(257): 38-39, 2020 Jan.
Artículo en Francés | MEDLINE | ID: mdl-32146965

RESUMEN

Financial difficulties, lack of social coverage and medical shortages contribute to the fact that many patients and their families in Uganda are left to fend for themselves. However, health care teams and associations are acting together to disseminate palliative culture while respecting cultural diversity. Nurses are very autonomous in their clinical expertise, providing care and visiting patients at home.


Asunto(s)
Cultura Organizacional , Cuidados Paliativos/organización & administración , Humanos , Uganda
3.
J Environ Manage ; 261: 110202, 2020 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-32148272

RESUMEN

The importance of faecal sludge management is gaining recognition. However, methods are still lacking to reasonably estimate the quantities and qualities (Q&Q) that need to be managed, which makes the planning for and implementing of management solutions quite difficult. The objective of this study was to collect and analyse Q&Q of faecal sludge at a citywide scale, and to evaluate whether "SPA-DET" data (=> spatially analysable - demographic, environmental and technical) could then be used as predictors of Q&Q of faecal sludge. 60 field samples and questionnaires from Hanoi and 180 from Kampala were analysed. Software tools were used in an iterative process to predict total solids (TS) and emptying frequency in both Hanoi, Vietnam and Kampala, Uganda. City-specific data could be predicted with types of "SPA-DET" data as input variables, and model performance was improved by analysing septic tanks and pit latrines separately. Individual models were built for TS concentrations and emptying frequency. In addition, a model was built across both cities for emptying frequency of septic tanks based on number of users and containment volume, indicating predictive models can be relevant for multiple cities. Number of users, containment volume, truck volume and income level were identified as the most common variables for the correction function. Results confirm the high intrinsic variability of faecal sludge characteristics, and illustrate the importance of moving beyond simple reporting of city-wide average values for estimations of Q&Q. The collected data and developed scripts have been made available for replication in future studies.


Asunto(s)
Saneamiento , Aguas del Alcantarillado , Ciudades , Uganda , Vietnam
4.
MMWR Morb Mortal Wkly Rep ; 69(9): 241-244, 2020 Mar 06.
Artículo en Inglés | MEDLINE | ID: mdl-32134908

RESUMEN

Plague, an acute zoonosis caused by Yersinia pestis, is endemic in the West Nile region of northwestern Uganda and neighboring northeastern Democratic Republic of the Congo (DRC) (1-4). The illness manifests in multiple clinical forms, including bubonic and pneumonic plague. Pneumonic plague is rare, rapidly fatal, and transmissible from person to person via respiratory droplets. On March 4, 2019, a patient with suspected pneumonic plague was hospitalized in West Nile, Uganda, 4 days after caring for her sister, who had come to Uganda from DRC and died shortly thereafter, and 2 days after area officials received a message from a clinic in DRC warning of possible plague. The West Nile-based Uganda Virus Research Institute (UVRI) plague program, together with local health officials, commenced a multipronged response to suspected person-to-person transmission of pneumonic plague, including contact tracing, prophylaxis, and education. Plague was laboratory-confirmed, and no additional transmission occurred in Uganda. This event transpired in the context of heightened awareness of cross-border disease spread caused by ongoing Ebola virus disease transmission in DRC, approximately 400 km to the south. Building expertise in areas of plague endemicity can provide the rapid detection and effective response needed to mitigate epidemic spread and minimize mortality. Cross-border agreements can improve ability to respond effectively.


Asunto(s)
Epidemias/prevención & control , Peste/prevención & control , Práctica de Salud Pública , Enfermedad Relacionada con los Viajes , Adulto , República Democrática del Congo/epidemiología , Femenino , Humanos , Peste/transmisión , Uganda/epidemiología , Adulto Joven
5.
Geneva; World Health Organization; 2020-03-22.
en Inglés | WHO IRIS | ID: who-331606
6.
Plant Dis ; 104(3): 853-859, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31910114

RESUMEN

Begomoviruses are plant viruses that cause major losses to many economically important crops. Although they are poorly understood, begomoviruses infecting wild plants may have an important role as reservoirs in the epidemiology of viral diseases. This study reports the discovery and genomic characterization of three novel bipartite begomoviruses from wild and cultivated African basil (Ocimum gratissimum) plants collected in Uganda, East Africa. Based on the symptoms shown by the infected plants, the names proposed for these viruses are Ocimum yellow vein virus (OcYVV), Ocimum mosaic virus (OcMV), and Ocimum golden mosaic virus (OcGMV). Genome and phylogenetic analyses suggest that DNA-A of OcGMV is mostly related to begomoviruses infecting tomato in Africa, whereas those of OcYVV and OcMV are closely related to one another and highly divergent within the Old World begomoviruses. The DNA-A of all characterized begomovirus isolates are of a recombinant nature, revealing the role of recombination in the evolution of these begomoviruses. The viruses characterized here are the first identified in O. gratissimum and the first in Ocimum spp. in the African continent and could have important epidemiological consequences for cultivated basils and other important crops.[Formula: see text] Copyright © 2020 The Author(s). This is an open access article distributed under the CC BY 4.0 International license.


Asunto(s)
Begomovirus , Ocimum basilicum , Ocimum , ADN Viral , Filogenia , Enfermedades de las Plantas , Uganda
7.
J Environ Manage ; 259: 110053, 2020 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-31929032

RESUMEN

Improving the sanitation situation in a community that relies on on-site sanitation requires information about the quantity and quality of faecal sludge (FS) produced. Existing tools for data collection about FS characteristics are either imprecise or very costly. As information and communication technologies are becoming more available in low-income countries, Citizen Science is becoming an option for the collection of sanitation data. This study used an online survey distributed via social media to predict FS characteristics (Total Solids (TS), Total Suspended Solids (TSS), Volatile Suspended Solids (VSS), Chemical Oxygen Demand (COD) and Sludge Volume Index (SVI)) at 40 households in Blantyre, Malawi. Furthermore, the study investigated whether and how an online survey could yield cost-effective and representative information about the sanitation situation at the household level. Facebook and WhatsApp both introduced a bias towards higher income households as low-income households still lack access to smartphones and internet. WhatsApp (€1.01/reply) was significantly cheaper than Facebook (€3.00/reply) and conventional data generation with household interviewers (€1.47-2.20/reply). Monetary incentives generated more replies than pure social messaging. TSS, VSS and COD were significantly correlated to TS. The slope of the regression line of COD to TS (0.97) was similar to one reported for Uganda (0.88), suggesting that the ratio of COD to TS might be independent of the location. Statistically significant median differences of TS concentrations were found for the survey parameters "system type" and "solid waste", making these parameters candidates for predictors of FS characteristics. The sample size was too small for the other survey parameters to detect any differences statistically. Overall, using social media in a Citizen Science approach appears to be a promising new tool for FS characterization. In the current form, it can probably not replace other data collection tools, but rather complement them as a cost-efficient method to gain an initial assessment. Besides sanitation planning, social media and the Citizen Science approach could be employed for data collection in various fields of development cooperation.


Asunto(s)
Saneamiento , Medios de Comunicación Sociales , Malaui , Aguas del Alcantarillado , Uganda
8.
BMC Med ; 18(1): 17, 2020 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-31996199

RESUMEN

BACKGROUND: There has been a successful push towards parasitological diagnosis of malaria in Africa, mainly with rapid diagnostic tests (mRDTs), which has reduced over-prescribing of artemisinin-based combination therapies (ACT) to malaria test-negative patients. The effect on prescribing for test-positive patients has received much less attention. Malaria infection in endemic Africa is often most dangerous for young children and those in low-transmission settings. This study examined non-prescription of antimalarials for patients with malaria infection demonstrated by positive mRDT results, and in particular these groups who are most vulnerable to poor outcomes if antimalarials are not given. METHODS: Analysis of data from 562,762 patients in 8 studies co-designed as part of the ACT Consortium, conducted 2007-2013 in children and adults, in Cameroon, Ghana, Nigeria, Tanzania, and Uganda, in a variety of public and private health care sector settings, and across a range of malaria endemic zones. RESULTS: Of 106,039 patients with positive mRDT results (median age 6 years), 7426 (7.0%) were not prescribed an ACT antimalarial. The proportion of mRDT-positive patients not prescribed ACT ranged across sites from 1.3 to 37.1%. For patients under age 5 years, 3473/44,539 (7.8%) were not prescribed an ACT, compared with 3833/60,043 (6.4%) of those aged ≥ 5 years. The proportion of < 5-year-olds not prescribed ACT ranged up to 41.8% across sites. The odds of not being prescribed an ACT were 2-32 times higher for patients in settings with lower-transmission intensity (using test positivity as a proxy) compared to areas of higher transmission. mRDT-positive children in low-transmission settings were especially likely not to be prescribed ACT, with proportions untreated up to 70%. Of the 7426 mRDT-positive patients not prescribed an ACT, 4121 (55.5%) were prescribed other, non-recommended non-ACT antimalarial medications, and the remainder (44.5%) were prescribed no antimalarial. CONCLUSIONS: In eight studies of mRDT implementation in five African countries, substantial proportions of patients testing mRDT-positive were not prescribed an ACT antimalarial, and many were not prescribed an antimalarial at all. Patients most vulnerable to serious outcomes, children < 5 years and those in low-transmission settings, were most likely to not be prescribed antimalarials, and young children in low-transmission settings were least likely to be treated for malaria. This major public health risk must be addressed in training and practice. TRIAL REGISTRATION: Reported in individual primary studies.


Asunto(s)
Antimaláricos/uso terapéutico , Artemisininas/uso terapéutico , Malaria/tratamiento farmacológico , Pautas de la Práctica en Medicina , Adolescente , Adulto , Niño , Preescolar , Prestación de Atención de Salud/normas , Femenino , Ghana , Humanos , Malaria/diagnóstico , Masculino , Persona de Mediana Edad , Nigeria , Prescripciones , Sector Privado , Tanzanía , Uganda , Adulto Joven
9.
BMC Health Serv Res ; 20(1): 17, 2020 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-31907036

RESUMEN

BACKGROUND: Many patients with epilepsy in sub-Saharan Africa do not receive adequate treatment. The purpose of the study was to identify the health care providers where patients with epilepsy sought care and what treatment they received. METHODS: A cross sectional study was conducted across 87 out of 312 villages in Masindi district. A total of 305 households having patients with epilepsy were surveyed using an interviewer administered questionnaire. Data was entered and analysed in Epi-info ver 7 for univariate and bivariate analysis, and in Stata SE ver 15.0 for multivariable analysis. Sequences of health providers consulted in care seeking, rationale and drugs used, and factors associated with choice of provider were assessed. RESULTS: A total of 139 out of 305 (45.6%) households offered some treatment regimen at home when patients got symptoms of epilepsy with 44.6% (62/139) giving herbs and 18.0% (25/139) offering prayers. Eight different types of providers were consulted as first contact providers for treatment of epilepsy. Health centres received the highest percentage 35.4% (108/305) followed by hospitals 20.9% (64/305). A total of 192 of 305 (63.0%) households received anti-epileptic drugs, 13.1% (40/305) received prayers and 21.6% (66/305) received herbs at the first contact care seeking. Compared to a health centre as the first choice provider, other facilities more significantly visited were; hospitals if they were perceived as nearer (adj. Coeff 2.16, 95%CI 0.74, 3.59, p = 0.003), churches / mosques if cure for epilepsy was expected (adj. Coeff 1.91, 95%CI 0.38, 3.48, p = 0.014), and traditional healer for those aged ≥46 years (adj. Coeff 5.83, 95%CI 0.67, 10.99, p = 0.027), and friends/neighbour for traders (adj. Coeff 2.87, 95%CI 0.71, 5.04, p = 0.009). CONCLUSION: Patients with epilepsy seek treatment from multiple providers with the public sector attending to the biggest proportion of patients. Engaging the private sector and community health workers, conducting community outreaches and community sensitization with messages tailored for audiences including the young, older epileptics, traditional healers as stakeholders, and traders could increase access to appropriate treatment for epilepsy.


Asunto(s)
Anticonvulsivantes/uso terapéutico , Epilepsia/terapia , Medicina Tradicional Africana/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Estudios Transversales , Epilepsia/tratamiento farmacológico , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Uganda , Adulto Joven
10.
PLoS One ; 15(1): e0224359, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31914129

RESUMEN

Sexually transmitted infections (STIs) and vaginal dysbiosis (disturbed resident microbiota presenting with abnormal Nugent score or candidiasis) have been associated with mucosal inflammation and risk of HIV-1 infection, cancer and poor reproductive outcomes. To date, the temporal relationships between aberrant cervical innate immunity and the clinical onset of microbial disturbance have not been studied in a large population of reproductive age women. We examined data from a longitudinal cohort of 934 Ugandan and Zimbabwean women contributing 3,274 HIV-negative visits who had complete laboratory, clinical and demographic data. Among those, 207 women later acquired HIV, and 584 women were intermittently diagnosed with C. trachomatis (CT), N. gonorrhoeae (NG), genital herpes (HSV-2), T. vaginalis (TV), candidiasis, and abnormal intermediate (4-6) or high (7-10) Nugent score, i.e. bacterial vaginosis (BV). Immune biomarker concentrations in cervical swabs were analyzed by generalized linear and mixed effect models adjusting for site, age, hormonal contraceptive use (HC), pregnancy, breastfeeding, genital practices, unprotected sex and overlapping infections. High likelihood ratios (1.5-4.9) denoted the values of cervical immune biomarkers to predict onset of abnormal Nugent score and candidiasis at the next visits. When controlling for covariates, higher levels of ß-defensin-2 were antecedent to BV, CT and HSV-2, lower anti-inflammatory ratio IL-1RA:IL-1ß-to intermediate Nugent scores and candida, lower levels of the serine protease inhibitor SLPI-to candida, lower levels of the adhesion molecule ICAM-1 -to TV, and lower levels of the oxidative stress mitigator and endothelial activation marker VEGF-to NG. Changes in innate immunity following onset of dysbiosis and infections were dependent on HC use when controlling for all other covariates. In conclusion, imminent female genital tract dysbiosis or infection can be predicted by distinct patterns of innate immunity. Future research should characterize biotic and abiotic determinants of this pre-existing innate immunity state.


Asunto(s)
Disbiosis/inmunología , Inmunidad Innata/genética , Enfermedades de Transmisión Sexual/inmunología , Vaginosis Bacteriana/inmunología , Adolescente , Adulto , Biomarcadores/metabolismo , Cuello del Útero/inmunología , Cuello del Útero/microbiología , Cuello del Útero/patología , Disbiosis/epidemiología , Disbiosis/microbiología , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/inmunología , Infecciones por VIH/virología , Humanos , Molécula 1 de Adhesión Intercelular/inmunología , Molécula 1 de Adhesión Intercelular/metabolismo , Proteína Antagonista del Receptor de Interleucina 1/inmunología , Proteína Antagonista del Receptor de Interleucina 1/metabolismo , Interleucina-1beta/inmunología , Interleucina-1beta/metabolismo , Estrés Oxidativo/inmunología , Embarazo , Infecciones del Sistema Genital/epidemiología , Infecciones del Sistema Genital/inmunología , Inhibidor Secretorio de Peptidasas Leucocitarias/inmunología , Inhibidor Secretorio de Peptidasas Leucocitarias/metabolismo , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/microbiología , Uganda/epidemiología , Vagina/inmunología , Vagina/microbiología , Vaginosis Bacteriana/epidemiología , Vaginosis Bacteriana/microbiología , Factor A de Crecimiento Endotelial Vascular/inmunología , Factor A de Crecimiento Endotelial Vascular/metabolismo , Zimbabwe/epidemiología
11.
BMC Health Serv Res ; 20(1): 30, 2020 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-31918695

RESUMEN

BACKGROUND: Pesticides are responsible for a significant percentage of deaths globally with majority occurring in sub-Saharan Africa. Deaths due to pesticide poisoning can be reduced if poisoning cases are managed optimally. However, the quality of care given to pesticide poisoning patients is still insufficient especially in sub-Saharan Africa. This study was aimed at exploring doctors' experiences on quality of care for pesticide poisoning cases in hospitals in Kampala, Uganda. METHODS: Fifteen (15) in-depth interviews were conducted with doctors who were directly involved in management of pesticide poisoning patients in the accident and emergency, Medicine, Pediatrics and Intensive Care Unit wards in 5 hospitals in Kampala, Uganda. All interviews were transcribed and subjected to directed content analysis with the guidance of the Donabedian model of quality of care which emphasizes structure, process and outcome measures as pertinent to ensuring quality of care. RESULTS: Doctors reported structural, process and outcome facets that support diagnosis and treatment of pesticide poisoning cases that improved the quality of care they provided. Among the structures includes hospital units such as Intensive Care Unit (ICU), pediatrics and internal medicine; equipment and clinical guidelines such as airway, breathing and consciousness (ABC) protocol; and doctors' knowledge and experiences. Doctors relied on history, and signs and symptoms to establish the cause and severity of pesticide poisoning. However, some patients and caretakers provided inaccurate pesticide poisoning history. Due to its availability in hospitals, doctors largely relied on atropine to manage pesticide poisoning cases whether or not relevant to treat the actual pesticide active ingredient responsible for the poisoning. Although majority of the cases treated recovered, those due to suicide were further referred to the hospital psychiatrist. Sharing experiences of managing pesticide poisoning patients among health workers and engaging in sensitization outreaches against pesticide poisoning were reported as potential activities to improve quality of care for pesticide poisoning patients. CONCLUSION: Doctors reflected on the structure, process and outcome measures of quality of care given to pesticide poisoning patients. The implications of hospital structures and clinical process to the quality of the outcomes of care demonstrates their importance in improving management of pesticide poisoning cases in hospitals in Kampala, Uganda.


Asunto(s)
Actitud del Personal de Salud , Cuerpo Médico de Hospitales/psicología , Plaguicidas/envenenamiento , Envenenamiento/terapia , Calidad de la Atención de Salud , Femenino , Hospitales , Humanos , Masculino , Cuerpo Médico de Hospitales/estadística & datos numéricos , Investigación Cualitativa , Resultado del Tratamiento , Uganda
12.
BMC Public Health ; 20(1): 43, 2020 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-31931768

RESUMEN

BACKGROUND: Violence exposure in adolescence is associated with a range of poor health and social outcomes, including both the perpetration and experience of violence in later intimate relationships. However, there is little longitudinal evidence on how both individual and contextual characteristics encourage or interrupt these associations. We designed the Contexts of Violence in Adolescence Cohort study (CoVAC) to provide evidence on these pathways for Ugandan adolescents, with the aim of providing information to improve the design of violence prevention interventions for adolescents and young adults. METHODS: CoVAC is a mixed-methods prospective cohort study with three parallel strands. Between 2014 and 2022, the study comprises three waves of quantitative survey data collection; qualitative data from five time points; and a series of workshops to facilitate direct use of emerging findings by intervention developers at Uganda-based NGO Raising Voices in their ongoing work to prevent violence. 3431 adolescents participated in a survey in 2014 when the majority were aged 11-14 years, and agreed to be re-contacted for a Wave 2 survey in 2018 (aged about 15-18 years); and again in 2021 (aged 18-21 years). 36 young people from Wave 1 survey sample will be invited to participate in longitudinal qualitative data collection. Adolescents aged 18 years and over will provide informed consent; for those under age 18 years, adolescents will be invited to assent, except in cases where caregivers, following notification, have opted not to consent to their adolescent's participation. Quantitative and qualitative data will be analysed iteratively, and triangulation will be used to confirm, clarify and deepen our interpretation of findings. We will hold regular structured meetings so that emerging findings can be integrated into intervention development. DISCUSSION: This will be the first longitudinal study on the aetiology of violence over adolescence in sub-Saharan Africa which will enable examination of pathways using mixed methods at multiple time points. Quantitative mediation analysis, and annual qualitative fieldwork will provide detailed insights into how adolescents' violence-related experiences, perspectives and practices relate to their social contexts and how these change over time. Results will feed directly into intervention development to reduce violence and harmful sequelae. TRIAL REGISTRATION: This study is a long-term follow up of participants in the Good Schools Study (NCT01678846, clinicaltrials.gov). This protocol is for cohort follow-up only; we have a separate protocol paper describing an evaluation of the long-term effects of the Good School Toolkit (In preparation).


Asunto(s)
Violencia/estadística & datos numéricos , Adolescente , Niño , Femenino , Humanos , Estudios Longitudinales , Masculino , Estudios Prospectivos , Investigación Cualitativa , Determinantes Sociales de la Salud , Encuestas y Cuestionarios , Uganda , Violencia/prevención & control , Adulto Joven
13.
PLoS One ; 15(1): e0218239, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31951608

RESUMEN

BACKGROUND: We explored the contributions of the Family Health Days (FHDs) concept, which was developed by the Uganda Ministry of Health (MOH) and UNICEF as a supplementary quarterly outreach program in addition to strengthening the routine expanded program for immunization (EPI), with the aim to increase coverage, through improved access to the unimmunized or unreached and under-immunized children under 5 years. METHOD: A cross-sectional descriptive study of the Uganda MOH, Health Management Information Systems (HMIS) and UNICEF in house FHDs data was conducted covering six quarterly implementations of the program between April 2012 and December 2013. The FHDs program was implemented in 31 priority districts with low routine vaccination coverage from seven sub-regions in Uganda in a phased manner using places of worship for service delivery. RESULTS: During the six rounds of FHDs in the 31 districts, a total of 178,709 and 191,223 children received measles and Diphtheria-Pertussis-Tetanus (DPT3) vaccinations, respectively. The FHDs' contributions were 126% and 144% for measles and 103% and 122% for DPT3 in 2012 and 2013, respectively of the estimated unreached annual target populations. All implementing sub-regions after two rounds in 2012 attained over and above the desired target for DPT3 (85%) and measles (90%). The same was true in 2013 after four rounds, except for Karamoja and West Nile sub-regions, where in some districts a substantial proportion of children remained unimmunized. The administrative data for both DPT3 and measles immunization showed prominent and noticeable increase in coverage trend in FHDS regions for the months when the program was implemented. CONCLUSION: The FHDs program improved vaccination equity by reaching the unreached and hard-to-reach children and bridging the gap in immunization coverage, and fast tracking the achievement of targets recommended by the Global Vaccine Action Plan (GVAP) for measles and DPT3 (85% and 90% respectively) in implementing sub-regions and districts. The FHDs is an innovative program to supplement routine immunizations designed to reach the unreached and under immunized children.


Asunto(s)
Vacuna contra Difteria, Tétanos y Tos Ferina/uso terapéutico , Sarampión/prevención & control , Vacunación , Niño , Preescolar , Estudios Transversales , Salud de la Familia , Femenino , Humanos , Programas de Inmunización , Lactante , Masculino , Sarampión/epidemiología , Sarampión/patología , Uganda/epidemiología , Cobertura de Vacunación
14.
PLoS One ; 15(1): e0218843, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31995567

RESUMEN

INTRODUCTION: Hospital based studies for psychotic disorders are scarce in low and middle income countries. This may impact on development of intervention programs. OBJECTIVE: We aimed to determine the burden of psychotic disorders among first treatment contact patients at the national psychiatric referral hospital in Uganda. METHODS: A retrospective patient chart-file review was carried out in March 2019 for all patients presenting to the hospital for the first time in the previous year. Patients were categorised into those with and without psychotic disorders. We collected sociodemographic data on age, gender, occupation, level of education, ethnicity, religion and home district. We determined the one year prevalence of psychotic disorders among first treatment contact patients. Using logistic regression models, we also determined the association between psychotic disorders and various exposure variables among first treatment contact patients. RESULTS: In 2018, 63% (95% CI: 60.2-65.1) of all first time contact patients had a psychosis related diagnosis. Among the patients with psychotic disorders, the median age was 29 years (IQR 24-36). Most of the patients were male (62.8%) and unemployed (63.1%). After adjusting for patients' residence, psychotic disorders were found to be more prevalent among the female gender [OR 1.58 (CI1.46-1.72)] and those of Pentecostal faith [OR 1.25 (CI 1.10-1.42)]. CONCLUSION: Among first treatment contact patients in Uganda, there is a large burden of psychotic disorders. The burden was more prevalent among females as well as people of Pentecostal faith who seemed to use their church for faith-based healing. Incidence studies are warranted to determine if this phenomenon is replicated at illness onset.


Asunto(s)
Salud Mental , Trastornos Psicóticos/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Catolicismo , Estudios de Cohortes , Femenino , Hospitales Psiquiátricos , Hospitales de Enseñanza , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/terapia , Derivación y Consulta , Religión , Uganda/epidemiología , Adulto Joven
15.
BMC Public Health ; 20(1): 29, 2020 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-31914966

RESUMEN

BACKGROUND: Compared to the general population in Uganda, fishing communities suffer greater burden of HIV/AIDS. We determined the level of comprehensive knowledge on HIV prevention and its associated factors among fishing communities of Lake Kyoga. METHODS: We conducted secondary analysis of data from the Lake Kyoga Behavioral Survey, a population-based sample survey on behavioral risk factors for HIV, syphilis, and schistosomiasis among adults in fishing communities of Lake Kyoga in 2013. We defined comprehensive knowledge as having correct knowledge on HIV prevention (consistent condom use, faithfulness, a healthy-looking person can have HIV, and HIV cannot be transmitted through food-sharing, witchcraft or handshake). We used logistic regression to determined potential factors associated with comprehensive knowledge on HIV prevention and control for confounding. RESULTS: Of 1780 persons in the sample, 51% (911/1780) were females. The mean age was 32 (range: 15-97) years. Overall, 51% (899/1780) of persons had comprehensive knowledge on HIV prevention. Level of comprehensive knowledge on HIV prevention was similar between females (52%, 449/911) and males (49%, 450/869). Males (76%, 658/869) had lower knowledge on HIV transmission from mother to child during breast feeding compared to females (81%, 738/911) (p-value 0.019). Fishermen (46%,324/711) who lived > 5 km away from a health center compared to 54% (572/1066) who lived within 5 km radius were less likely to have comprehensive knowledge on HIV prevention (PRRadj = 0.8; 95%CI = 0.5-0.92). Those who had ever tested for HIV were more likely to have comprehensive knowledge of HIV transmission (PRRadj = 1.1; 95% 1.03-1.70). CONCLUSION: Half of the population of Lake Kyoga fishing community had comprehensive knowledge of HIV prevention. Long distances from health facilities reduced the level of comprehensive knowledge on HIV transmission. HIV testing increased the level of comprehensive knowledge on HIV transmission. Ministry of health should ensure that HIV/AIDS information; education and communication and HIV counseling and testing activities are intensified in fishing communities of Lake Kyoga, with more emphasis on communities living in distances of more than 5 km away from the health facility.


Asunto(s)
Explotaciones Pesqueras , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Uganda/epidemiología , Adulto Joven
16.
PLoS One ; 15(1): e0222801, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31940346

RESUMEN

BACKGROUND: Hypertension (HTN) is the single leading risk factor for human mortality worldwide, and more prevalent in sub-Saharan Africa than any other region [1]-although resources for HTN screening, treatment, and control are few. Most regional pilot studies to leverage HIV programs for HTN control have achieved blood pressure control in half of participants or fewer [2,3,4]. But this control gap may be due to inconsistent delivery of services, rather than ineffective underlying interventions. METHODS: We sought to evaluate the consistency of HTN program delivery within the SEARCH study (NCT01864603) among 95,000 adults in 32 rural communities in Uganda and Kenya from 2013-2016. To achieve this objective, we designed and performed a fidelity evaluation of the step-by-step process (cascade) of HTN care within SEARCH, calculating rates of HTN screening, linkage to care, and follow-up care. We evaluated SEARCH's assessment of each participant's HTN status against measured blood pressure and HTN history. FINDINGS: SEARCH completed blood pressure screens on 91% of participants. SEARCH HTN screening was 91% sensitive and over 99% specific for HTN relative to measured blood pressure and patient history. 92% of participants screened HTN+ received clinic appointments, and 42% of persons with HTN linked to subsequent care. At follow-up, 82% of SEARCH clinic participants received blood pressure checks; 75% received medication appropriate for their blood pressure; 66% remained in care; and 46% had normal blood pressure at their most recent visit. CONCLUSION: The SEARCH study's consistency in delivering screening and treatment services for HTN was generally high, but SEARCH could improve effectiveness in linking patients to care and achieving HTN control. Its model for implementing population-scale HTN testing and care through an existing HIV test-and-treat program-and protocol for evaluating the intervention's stepwise fidelity and care outcomes-may be adapted, strengthened, and scaled up for use across multiple resource-limited settings.


Asunto(s)
Presión Sanguínea , Infecciones por VIH/epidemiología , Hipertensión/epidemiología , Tamizaje Masivo , Adolescente , Adulto , Instituciones de Atención Ambulatoria , Determinación de la Presión Sanguínea , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/patología , Infecciones por VIH/terapia , Humanos , Hipertensión/complicaciones , Hipertensión/patología , Hipertensión/terapia , Kenia/epidemiología , Masculino , Persona de Mediana Edad , Población Rural , Uganda/epidemiología , Adulto Joven
17.
MMWR Morb Mortal Wkly Rep ; 69(1): 10-13, 2020 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-31917781

RESUMEN

Tailoring communicable disease preparedness and response strategies to unique population movement patterns between an outbreak area and neighboring countries can help limit the international spread of disease. Global recognition of the value of addressing community connectivity in preparedness and response, through field work and visualizing the identified movement patterns, is reflected in the World Health Organization's declaration on July 17, 2019, that the 10th Ebola virus disease (Ebola) outbreak in the Democratic Republic of the Congo (DRC) was a Public Health Emergency of International Concern (1). In March 2019, the Infectious Diseases Institute (IDI), Uganda, in collaboration with the Ministry of Health (MOH) Uganda and CDC, had previously identified areas at increased risk for Ebola importation by facilitating community engagement with participatory mapping to characterize cross-border population connectivity patterns. Multisectoral participants identified 31 locations and associated movement pathways with high levels of connectivity to the Ebola outbreak areas. They described a major shift in the movement pattern between Goma (DRC) and Kisoro (Uganda), mainly through Rwanda, when Rwanda closed the Cyanika ground crossing with Uganda. This closure led some travelers to use a potentially less secure route within DRC. District and national leadership used these results to bolster preparedness at identified points of entry and health care facilities and prioritized locations at high risk further into Uganda, especially markets and transportation hubs, for enhanced preparedness. Strategies to forecast, identify, and rapidly respond to the international spread of disease require adapting to complex, dynamic, multisectoral cross-border population movement, which can be influenced by border control and public health measures of neighboring countries.


Asunto(s)
Brotes de Enfermedades , Fiebre Hemorrágica Ebola/epidemiología , Migración Humana/estadística & datos numéricos , Participación de la Comunidad , República Democrática del Congo/epidemiología , Brotes de Enfermedades/prevención & control , Fiebre Hemorrágica Ebola/prevención & control , Humanos , Rwanda/epidemiología , Uganda/epidemiología
18.
MMWR Morb Mortal Wkly Rep ; 69(1): 14-19, 2020 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-31917783

RESUMEN

On August 1, 2018, the Democratic Republic of the Congo (DRC) declared its 10th Ebola virus disease (Ebola) outbreak in an area with a high volume of cross-border population movement to and from neighboring countries. The World Health Organization (WHO) designated Rwanda, South Sudan, and Uganda as the highest priority countries for Ebola preparedness because of the high risk for cross-border spread from DRC (1). Countries might base their disease case definitions on global standards; however, historical context and perceived risk often affect why countries modify and adapt definitions over time, moving toward or away from regional harmonization. Discordance in case definitions among countries might reduce the effectiveness of cross-border initiatives during outbreaks with high risk for regional spread. CDC worked with the ministries of health (MOHs) in DRC, Rwanda, South Sudan, and Uganda to collect MOH-approved Ebola case definitions used during the first 6 months of the outbreak to assess concordance (i.e., commonality in category case definitions) among countries. Changes in MOH-approved Ebola case definitions were analyzed, referencing the WHO standard case definition, and concordance among the four countries for Ebola case categories (i.e., community alert, suspected, probable, confirmed, and case contact) was assessed at three dates (2). The number of country-level revisions ranged from two to four, with all countries revising Ebola definitions by February 2019 after a December 2018 peak in incidence in DRC. Case definition complexity increased over time; all countries included more criteria per category than the WHO standard definition did, except for the "case contact" and "confirmed" categories. Low case definition concordance and lack of awareness of regional differences by national-level health officials could reduce effectiveness of cross-border communication and collaboration. Working toward regional harmonization or considering systematic approaches to addressing country-level differences might increase efficiency in cross-border information sharing.


Asunto(s)
Brotes de Enfermedades , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/epidemiología , Vigilancia en Salud Pública/métodos , República Democrática del Congo/epidemiología , Humanos , Rwanda/epidemiología , Sudán del Sur/epidemiología , Factores de Tiempo , Uganda/epidemiología
19.
PLoS One ; 15(1): e0216689, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31978111

RESUMEN

BACKGROUND: Tuberculosis (TB) non-disclosure by adult patients to all household members is a setback to TB control efforts. It reduces the likelihood that household contacts will seek early TB screening, initiation on preventive or curative treatment, but also hinders the implementation of infection controls and home-based directly observed treatment. Therefore, the purpose of this study was to determine the level of TB non-disclosure, its predictors and the effects of disclosure among adult TB patients in Uganda. METHODS: We conducted a cross-sectional study at a large regional referral hospital in Mbarara, south-western Uganda. Questionnaires were administered to collect patients' sociodemographic and their TB disclosure data. Non-disclosure was considered if a patient did not reveal their TB diagnosis to all household members within 2 weeks post-treatment initiation. Univariate and multivariate logistic regression models were fitted for predictors of non-disclosure. RESULTS: We enrolled 62 patients, 74% males, mean age of 32 years, and median of five people per household. Non-disclosure rate was 30.6%. Post-disclosure experiences were positive in 98.3% of patients, while negative experiences suggestive of severe stigma occurred in 12.3% of patients. Being female (OR 6.5, 95% CI: 1.4-29.3) and belonging to Muslim faith (OR 12.4, 95% CI: 1.42-109.1) were significantly associated with TB non-disclosure to household members. CONCLUSIONS: There is a high rate of TB non-disclosure to all household members by adult patients in rural Uganda, particularly among women and muslim patients. Interventions enhancing TB disclosure at household level while minimizing negative effects of stigma should be developed and prioritized.


Asunto(s)
Revelación , Infecciones por VIH/psicología , Tuberculosis/diagnóstico , Tuberculosis/psicología , Adulto , Estudios Transversales , Familia/psicología , Composición Familiar , Femenino , VIH/patogenicidad , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , Humanos , Islamismo/psicología , Masculino , Tamizaje Masivo/psicología , Persona de Mediana Edad , Estigma Social , Tuberculosis/complicaciones , Tuberculosis/epidemiología , Uganda/epidemiología
20.
PLoS One ; 15(1): e0220484, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31990938

RESUMEN

The growing occurrence of multidrug-resistant (MDR) Salmonella enterica in poultry has been reported with public health concern worldwide. We reported, recently, the occurrence of Escherichia coli and Salmonella enterica serovars carrying clinically relevant resistance genes in dairy cattle farms in the Wakiso District, Uganda, highlighting an urgent need to monitor food-producing animal environments. Here, we present the prevalence, antimicrobial resistance, and sequence type of 51 Salmonella isolates recovered from 379 environmental samples from chicken farms in Uganda. Among the Salmonella isolates, 32/51 (62.7%) were resistant to at least one antimicrobial, and 10/51 (19.6%) displayed multiple drug resistance. Through PCR, five replicon plasmids were identified among chicken Salmonella isolates including IncFIIS 17/51 (33.3%), IncI1α 12/51 (23.5%), IncP 8/51 (15.7%), IncX1 8/51 (15.7%), and IncX2 1/51 (2.0%). In addition, we identified two additional replicons through WGS (Whole Genome Sequencing; ColpVC and IncFIB). A significant seasonal difference between chicken sampling periods was observed (p = 0.0017). We conclude that MDR Salmonella highlights the risks posed to animals and humans. Implementing a robust, integrated surveillance system will aid in monitoring MDR zoonotic threats.


Asunto(s)
Farmacorresistencia Bacteriana Múltiple/genética , Genes Bacterianos , Plásmidos/metabolismo , Enfermedades de las Aves de Corral/epidemiología , Infecciones por Salmonella/epidemiología , Salmonella enterica/genética , Animales , Antibacterianos/clasificación , Antibacterianos/farmacología , Pollos/microbiología , Granjas , Humanos , Vigilancia Inmunológica , Plásmidos/química , Enfermedades de las Aves de Corral/microbiología , Enfermedades de las Aves de Corral/transmisión , Prevalencia , Replicón , Infecciones por Salmonella/microbiología , Infecciones por Salmonella/transmisión , Salmonella enterica/efectos de los fármacos , Salmonella enterica/aislamiento & purificación , Estaciones del Año , Uganda/epidemiología , Secuenciación Completa del Genoma
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA