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1.
BMJ Open ; 11(3): e045427, 2021 03 31.
Artículo en Inglés | MEDLINE | ID: mdl-33789856

RESUMEN

OBJECTIVES: This study aimed to determine the lifetime prevalence of male-perpetrated intimate partner violence (IPV), and to assess the association with food insecurity, sociodemographic factors and health risk behaviours in Uganda in the year preceding COVID-19-associated lockdowns. DESIGN: Population-based, cross-sectional household survey. SETTING: Urban, semiurban and rural communities of the Wakiso and Hoima districts in Uganda. PARTICIPANTS: A total of N=2014 males aged 13-80 years participated in the survey. The current study included males who reported having ever been in a sexual union and responded to the IPV questions (N=1314). MEASURES: Data were collected face-to-face from May 2018 to July 2019 using an interviewer-mediated questionnaire. Lifetime IPV perpetration was measured as 'no physical and/or sexual IPV', 'physical' versus 'sexual violence only', and 'physical and sexual violence'. Past-year food insecurity was measured through the Food Insecurity Experience Scale and categorised into 'none', 'low' and 'high'. Multinomial logistic regression was used to determine the crude and adjusted relative risk ratios (aRRRs) of IPV perpetration in relation to self-reported food insecurity, adjusting for sociodemographic and health risk behaviours. RESULTS: The prevalence of self-reported lifetime IPV perpetration was 14.6% for physical and 6.5% for sexual violence, while 5.3% reported to have perpetrated both physical and sexual IPV. Most (75.7%) males reported no food insecurity, followed by low (20.7%) and high (3.6%) food insecurity. In adjusted models, food insecurity was associated with increased risk of having perpetrated both physical and sexual violence (aRRR=2.57, 95% CI 1.52 to 4.32). IPV perpetration was also independently associated with having had more than one lifetime sexual partner and drinking alcohol, but not with education level or religion. CONCLUSION: This study suggests that food insecurity is associated with male IPV perpetration, and more efforts are needed to prevent and mitigate the expected worsening of this situation as a result of the COVID-19 pandemic.


Asunto(s)
Violencia de Pareja/estadística & datos numéricos , Parejas Sexuales/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Humanos , Violencia de Pareja/psicología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Población Rural , Autoinforme , Población Suburbana , Encuestas y Cuestionarios , Uganda/epidemiología , Población Urbana , Adulto Joven
2.
BMC Med Educ ; 21(1): 215, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33863332

RESUMEN

BACKGROUND: Uganda has an imbalanced distribution of the health workforce, which may be influenced by the specialty career preferences of medical students. In spite of this, there is inadequate literature concerning the factors influencing specialty career preferences. We aimed to determine the specialty career preferences and the factors influencing the preferences among fifth year medical students in the School of Medicine, Makerere University College of Health Sciences (MakCHS). METHODS: A sequential explanatory mixed methods study design with a descriptive cross-sectional study followed by a qualitative study was used. A total of 135 final year medical students in MakCHS were recruited using consecutive sampling. Self-administered questionnaires and three focus group discussions were conducted. Quantitative data was analysed in STATA version 13 (StataCorp, College Station, Tx, USA) using descriptive statistics, chi-square tests and logistic regression. Qualitative data was analysed in NVIVO version 12 (QRS International, Cambridge, MA) using content analysis. RESULTS: Of 135 students 91 (67.4%) were male and their median age was 24 years (IQR: 24, 26). As a first choice, the most preferred specialty career was obstetrics and gynecology (34/135, 25.2%), followed by surgery (27/135, 20.0%), pediatrics (18/135, 13.3%) and internal medicine (17/135, 12.6%). Non-established specialties such as anesthesia and Ear Nose and Throat (ENT) were not selected as a first choice by any student. Female students had 63% less odds of selecting surgical related specialties compared to males (aOR = 0.37, 95%CI: 0.17-0.84). The focus group discussions highlighted controlled lifestyle, assurance of a good life through better financial remuneration and inspirational specialists as facilitators for specialty preference. Bad experience during the clinical rotations, lack of career guidance plus perceived poor and miserable specialists were highlighted as barriers to specialty preference. CONCLUSION: Obstetrics and Gynecology, Surgery, Pediatrics and Internal Medicine are well-established disciplines, which were dominantly preferred. Females were less likely to select surgical disciplines as a career choice. Therefore, there is a need to implement or establish career guidance and mentorship programs to attract students to the neglected disciplines.


Asunto(s)
Selección de Profesión , Conducta de Elección , Especialización/estadística & datos numéricos , Estudiantes de Medicina/psicología , Adulto , Niño , Estudios Transversales , Educación Médica , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Uganda , Universidades , Adulto Joven
3.
Pan Afr Med J ; 38: 130, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33912300

RESUMEN

Introduction: the Democratic Republic of Congo (DRC) declared its 10thoutbreak of Ebola virus disease (EVD) in 42 years on August 1st 2018. The rapid rise and spread of the EVD outbreak threatened health security in neighboring countries and global health security. The United Nations developed an EVD preparedness and readiness (EVD-PR) plan to assist the nine neighboring countries to advance their critical preparedness measures. In Uganda, EVD-PR was implemented between 2018 and 2019. The World Health Organization commissioned an independent evaluation to assess the impact of the investment in EVD-PR in Uganda. Objectives: i) to document the program achievements; ii) to determine if the capacities developed represented good value for the funds and resources invested; iii) to assess if more cost-effective or sustainable alternative approaches were available; iv) to explore if the investments were aligned with country public health priorities; and v) to document the factors that contributed to the program success or failure. Methods: during the EVD preparedness phase, Uganda's government conducted a risk assessment and divided the districts into three categories, based on the potential risk of EVD. Category I included districts that shared a border with the DRC provinces where EVD was ongoing or any other district with a direct transport route to the DRC. Category II were districts that shared a border with the DRC but not bordering the DRC provinces affected by the EVD outbreak. Category III was the remaining districts in Uganda. EVD-PR was implemented at the national level and in 22 category I districts. We interviewed key informants involved in program design, planning and implementation or monitoring at the national level and in five purposively selected category I districts. Results: Ebola virus disease preparedness and readiness was a success and this was attributed mainly to donor support, the ministry of health's technical capacity, good coordination, government support and community involvement. The resources invested in EVD-PR represented good value for the funds and the activities were well aligned to the public health priorities for Uganda. Conclusion: Ebola virus disease preparedness and readiness program in Uganda developed capacities that played an essential role in preventing cross border spread of EVD from the affected provinces in the DRC and enabled rapid containment of the two importation events. These capacities are now being used to detect and respond to the COVID-19 pandemic.


Asunto(s)
/prevención & control , Brotes de Enfermedades/prevención & control , Fiebre Hemorrágica Ebola/prevención & control , /epidemiología , Defensa Civil/organización & administración , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Salud Pública , Uganda/epidemiología
4.
Artículo en Inglés | MEDLINE | ID: mdl-33806590

RESUMEN

Menstrual hygiene management and health is increasingly gaining policy importance in a bid to promote dignity, gender equality and reproductive health. Effective and adequate menstrual hygiene management requires women and girls to have access to their menstrual health materials and products of choice, but also extends into having private, clean and safe spaces for using these materials. The paper provides empirical evidence of the inequality in menstrual hygiene management in Kinshasa (DRC), Ethiopia, Ghana, Kenya, Rajasthan (India), Indonesia, Nigeria and Uganda using concentration indices and decomposition methods. There is consistent evidence of wealth-related inequality in the conditions of menstrual hygiene management spaces as well as access to sanitary pads across all countries. Wealth, education, the rural-urban divide and infrastructural limitations of the household are major contributors to these inequalities. While wealth is identified as one of the key drivers of unequal access to menstrual hygiene management, other socio-economic, environmental and household factors require urgent policy attention. This specifically includes the lack of safe MHM spaces which threaten the health and dignity of women and girls.


Asunto(s)
Higiene , Pobreza , República Democrática del Congo , Países en Desarrollo , Etiopía , Femenino , Ghana , Conocimientos, Actitudes y Práctica en Salud , Humanos , India , Indonesia , Kenia , Menstruación , Nigeria , Uganda
5.
Water Res ; 197: 117068, 2021 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-33845279

RESUMEN

Reuse of faecal sludge in agriculture has many potential benefits, but also poses risks to human health. To better understand the potential risks, Quantitative Microbial Risk Assessment (QMRA) was performed for three population groups in Kampala, Uganda: wastewater and faecal sludge treatment plant workers; farmers using faecal sludge; and consumers of faecal sludge-fertilised vegetables. Two models were applied for farmers and consumers, one based on pathogen concentrations from field sampling of sludge, soils and vegetables, and one based on theoretical pathogen contribution from the last sludge application, including decay and soil to crop transfer of pathogens. The risk was evaluated for two pathogens (enterohaemorrhagic E. coli (EHEC) and Ascaris lumbricoides). The field data on sludge, soil and vegetables indicated that the last application of faecal sludge was not the sole pathogen source. Correspondingly, the model using field data resulted in higher risks for farmers and consumers than the theoretical model assuming risk from sludge only, except when negligible for both. For farmers, the yearly risk of illness, based on measured concentrations, was 26% from EHEC and 70% from Ascaris, compared with 1.2% and 1.4%, respectively, considering the theoretically assumed contribution from the sludge. For consumers, the risk of illness based on field samples was higher from consumption of leafy vegetables (100% from EHEC, 99% from Ascaris) than from consumption of cabbages (negligible for EHEC, 26% from Ascaris). With the theoretical model, the risk of illness from EHEC was negligible for both crops, whereas the risk of illness from Ascaris was 64% and 16% for leafy vegetables and cabbage, respectively. For treatment plant workers, yearly risk of illness was 100% from EHEC and 99.4% from Ascaris. Mitigation practices evaluated could reduce the relative risk by 30-70%. These results can help guide treatment and use of faecal sludge in Kampala, to protect plant workers, farmers and consumers.


Asunto(s)
Escherichia coli , Aguas del Alcantarillado , Agricultura , Animales , Humanos , Modelos Teóricos , Uganda
6.
Ecotoxicol Environ Saf ; 214: 112094, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33677382

RESUMEN

Honey has multifaceted nutritional and medicinal values; however, its quality is hinged on the floral origin of the nectar. Taking advantage of the large areas that they cover; honeybees are often used as bioindicators of environmental contamination. The focus of the present paper was to examine the quality of honey from within the vicinity of an abandoned pesticide store in Masindi District in western Uganda. Surficial soils (<20 cm depths) and honey samples were collected from within the vicinity of the abandoned pesticide store and analysed for organochlorine pesticide (OCP) residues using gas chromatograph coupled to an electron capture detector (GC-ECD). The mean level of ∑DDTs in all the soil samples was 503.6 µg/kg dry weight (d.w). ∑DDTs contributed 92.2% to the ∑OCPs contamination loads in the soil samples, and others (lindane, aldrin, dieldrin, and endosulfans) contributed only 7.8%. Ratio (p, p'-DDE+p, p'-DDD)/p, p'-DDT of 1.54 suggested historical DDT input in the area. In all the honey samples, the mean level of ∑DDTs was 20.9 µg/kg. ∑DDTs contributed 43.3% to ∑OCPs contamination loads in the honey samples, followed by lindane (29.8%), endosulfans (23.6%) and dieldrin (3.2%), with corresponding mean levels of 14.4, 11.4 and 1.55 µg/kg, respectively. Reproductive risk assessment was done based on the hazard quotient (HQ) and hazard index (HI) procedure. In our study, the calculated HIs for adults (102.38), and children (90.33) suggested high potential health risks to the honey consumers. Lindane, endosulfan and p, p'-DDD detected in the honey samples at levels exceeding the acute reference dose (ARfD) are known risk factors for spontaneous abortion, reduced implantation, menstrual cycle shortening, impaired semen quality, and prostate cancer in exposed individuals and experimental animal models.


Asunto(s)
Exposición Dietética/estadística & datos numéricos , Miel/análisis , Hidrocarburos Clorados/análisis , Residuos de Plaguicidas/análisis , Adulto , Aldrín/análisis , Animales , Niño , DDT/análisis , Diclorodifenil Dicloroetileno/análisis , Dieldrín/análisis , Endosulfano/análisis , Biomarcadores Ambientales , Monitoreo del Ambiente/métodos , Femenino , Hexaclorociclohexano/análisis , Humanos , Masculino , Plaguicidas/análisis , Salud Reproductiva , Análisis de Semen , Suelo , Uganda
7.
BMC Public Health ; 21(1): 482, 2021 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-33706737

RESUMEN

BACKGROUND: Quarantine has been adopted as a key public health measure to support the control of the Coronavirus disease (COVID-19) pandemic in many countries Uganda adopted institutional quarantine for individuals suspected of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to be placed in institutions like hotels and/or hostels of institutions for at least 14 days. This study explored experiences of individuals who underwent institutional quarantine in Uganda to inform measures to increase its effectiveness and reduce its associated negative impact. METHODS: We conducted a qualitative description study using in-depth interviews with 20 purposively selected individuals who had spent time in institutional quarantine facilities. These were mainly phone-based interviews that were audio recorded and transcribed verbatim. Electronic data coding was conducted using Atlas.ti 7 software. Thematic content analysis was used to synthesize the findings with similar codes grouped to form sub-themes and ultimately study themes. The findings are presented thematically with typical participant quotes. RESULTS: Study participants spent between 14 to 25 days in institutional quarantine. Four themes emerged describing the experiences of study participants during institutional quarantine, which determined whether participants' experiences were positive or negative. These themes were: quarantine environment including facility related factors and compliance with COVID-19 measures; quarantine management factors of entity paying the costs, communication and days spent in quarantine; individual factors comprising attitude towards quarantine, fears during and post-quarantine and coping mechanisms; and linkage to other services such as health care and post-quarantine follow-up. CONCLUSION: The planning, management and implementation of the quarantine process is a key determinant of the experiences of individuals who undergo the measure. To improve the experience of quarantined individuals and reduce its associated negative impact, the pre-quarantine process should be managed to comply with standards, quarantined persons should be provided as much information as possible, their quarantine duration should kept short and costs of the process ought to be minimised. Furthermore, quarantine facilities should be assessed for suitability and monitored to comply with guidelines while avenues for access to healthcare for the quarantined need to be arranged and any potential stigma associated with quarantine thoroughly addressed.


Asunto(s)
/prevención & control , Cuarentena/psicología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Uganda
8.
BMC Public Health ; 21(1): 467, 2021 03 08.
Artículo en Inglés | MEDLINE | ID: mdl-33685420

RESUMEN

BACKGROUND: In March 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. Many countries in Sub-Saharan Africa, Uganda inclusive, implemented lockdowns, curfew, banning of both private and public transport systems, and mass gatherings to minimize spread. Social control measures for COVID-19 are reported to increase violence and discrimination globally, including in Uganda as some may be difficult to implement resulting in the heavy deployment of law enforcement. Media reports indicated that cases of violence and discrimination had increased in Uganda's communities following the lockdown. We estimated the incidence and factors associated with experiencing violence and discrimination among Ugandans during the COVID-19 lockdown to inform control and prevention measures. METHODS: In April 2020, we conducted a secondary analysis of cross-sectional data under the International Citizen Project (ICP) to assess adherence to public health measures and their impact on the COVID-19 outbreak in Uganda. We analyzed data on violence and discrimination from the ICP study. We performed descriptive statistics for all the participants' characteristics and created a binary outcome variable called experiencing violence and/or discrimination. We performed logistic regression analysis to identify the factors associated with experiencing violence and discrimination. RESULTS: Of the 1726 ICP study participants, 1051 (58.8%) were males, 841 (48.7%) were currently living with a spouse or partner, and 376 (21.8%) had physically attended work for more than 3 days in the past week. Overall, 145 (8.4%) experienced any form of violence and/or discrimination by any perpetrator, and 46 (31.7%) of the 145 reported that it was perpetrated by a law enforcement officer. Factors associated with experiencing violence or discrimination were: being male (AOR = 1.60 CI:1.10-2.33), having attended work physically for more than 3 days in the past week (AOR = 1.52 CI:1.03-2.23), and inability to access social or essential health services since the epidemic started (AOR = 3.10 CI:2.14-4.50). CONCLUSION: A substantial proportion of Ugandan residents experienced violence and/or discrimination during the COVID-19 lockdown, mostly perpetrated by law enforcement officers. We recommend mitigation of the collateral impact of lockdowns with interventions that focus on improving policing quality, ensuring continuity of essential services, and strengthening support systems for vulnerable groups including males.


Asunto(s)
/prevención & control , Control de Enfermedades Transmisibles/estadística & datos numéricos , Prejuicio/psicología , Violencia/psicología , Violencia/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Prejuicio/estadística & datos numéricos , Uganda/epidemiología , Adulto Joven
9.
Harefuah ; 160(3): 181-185, 2021 03.
Artículo en Hebreo | MEDLINE | ID: mdl-33749182

RESUMEN

INTRODUCTION: Elective clerkships in low income countries have been an integral part of the curriculum in the majority of medical schools worldwide. These programs expose students to global challenges, to a diversity of cultures and healthcare systems, and have been shown to improve medical knowledge, as well as clinical and communication skills. In 2018 and 2019, the Faculty of Medicine at the Technion, in cooperation with the Department for Infectious Diseases in the Rambam Health Care campus and the "Brit Olam" nonprofit organization, offered a clinical clerkship in Kiboga hospital, Uganda. The elective took place in a public governmental hospital located in one of the poorest districts of Uganda. During a three-week period, the students accompanied by Israeli and Uganda tutors, participated in clinical rounds and other clinical activities in various departments of the hospital. This manuscript, describes the students' experiences in Kiboga. During the short elective, students had a unique opportunity to observe a different culture, immerse in a completely different healthcare system, learn about how a detailed medical history and a thorough physical examination can lead to diagnosis (without extensive diagnostic tests), and closely observe ethical challenges and difficult clinical decisions. The elective helped students develop personally and professionally and solidify their commitment to medicine. Currently, in Israeli medical schools, there are a few programs which expose students to medicine in low-resource countries. We believe that expanding the understanding of Global Health through courses and overseas opportunities in long-term partnerships, can improve the students' medical education.


Asunto(s)
Prácticas Clínicas , Educación Médica , Estudiantes de Medicina , Curriculum , Humanos , Facultades de Medicina , Uganda
10.
BMC Infect Dis ; 21(1): 292, 2021 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-33752637

RESUMEN

BACKGROUND: The World Health Organization (WHO) End TB strategy aims to reduce mortality due to tuberculosis (TB) to less than 5% by 2035. However, mortality due to multidrug-resistant tuberculosis (MDR-TB) remains particularly high. Globally, almost 20% of patients started on MDR-TB treatment die during the course of treatment every year. We set out to examine the risk factors for mortality among a cohort of patients diagnosed with MDR-TB in Uganda. METHODS: We conducted a case-control study nested within the national MDR-TB cohort. We defined cases as patients who died from any cause during the course of MDR-TB treatment. We selected two controls for each case from patients alive and on MDR-TB treatment at the time that the death occurred (incidence-density sampling). We matched the cases and controls on health facility at which they were receiving care. We performed conditional logistic regression to identify the risk factors for mortality. RESULTS: Data from 198 patients (66 cases and 132 controls) started on MDR-TB treatment from January 1 to December 31, 2016, was analyzed for this study. Cases were similar to controls in age/sex distribution, occupation and history of TB treatment. However, cases were more likely to be HIV infected while controls were more likely to have attained secondary level education. On multivariate regression analysis, co-infection with HIV (aOR 1.9, 95% CI [1.1-4.92] p = 0.05); non-adherence to MDR-TB treatment (aOR 1.92, 95% CI [1.02-4.83] p = 0.04); age over 50 years (aOR 3.04, 95% CI [1.13-8.20] p = 0.03); and having no education (aOR 3.61, 95% CI [1.1-10.4] p = 0.03) were associated with MDR-TB mortality. CONCLUSION: To mitigate MDR-TB mortality, attention must be paid to provision of social support particularly for older persons on MDR-TB treatment. In addition, interventions that support treatment adherence and promote early detection and management of TB among HIV infected persons should also be emphasized.


Asunto(s)
Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Adolescente , Adulto , Antituberculosos/uso terapéutico , Estudios de Casos y Controles , Niño , Preescolar , Coinfección/diagnóstico , Escolaridad , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Humanos , Lactante , Recién Nacido , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Oportunidad Relativa , Factores de Riesgo , Análisis de Supervivencia , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/mortalidad , Uganda/epidemiología , Adulto Joven
11.
Health Qual Life Outcomes ; 19(1): 84, 2021 Mar 10.
Artículo en Inglés | MEDLINE | ID: mdl-33691720

RESUMEN

BACKGROUND: Bipolar disorder is a psychiatric disorder that alters mood and affects over 55 million people globally with an estimated lifetime prevalence of approximately 0.8-1.1%. In Africa, the lifetime prevalence of the bipolar spectrum disorders is slightly lower at 0.1-0.6%. Bipolar disorder is ranked the sixth leading cause of disability with high rates of morbidity and mortality and negatively impacts quality of life of those affected. METHODS: The aim of the study was to determine the health-related quality of life of patients with bipolar disorder attending a mental health clinic in south western Uganda. We enrolled a consecutive sample of 169 participants and evaluated their health-related quality of life using the medical outcomes health survey short form-36 (SF-36) scale. We used bivariate and multivariable logistic regression to determine associations between quality of life, sociodemographic and clinical factors setting the physical and mental component categories of quality life scale as the main outcome variables. RESULTS: The mean age of the participants was 37.23 (12.83) and slightly over half (54.4%) were females. More than half (66.86%) of the participants had poor physical component summary (mean = 45.06, SD = 8.44) while 81% of the participants had poor mental component summary (mean = 41.95, SD = 8.45). Poor physical quality of life had a statistically significant association with history of suicidal thoughts (OR = 2.75, 95% CI = 1.14-6.63, P = 0.02), while poor mental quality of life had a statistically significant association with history of suicidal thoughts (OR = 3.94, CI = 1.22-12.71, P = 0.02) and history of psychotic symptoms (OR = 2.46, CI = 1.07-5.64, P = 0.03). CONCLUSION: The mental and physical quality of life of our participants was poor and history of suicidal thoughts and psychotic symptoms were associated with poor quality of life. There is need to address psychotic symptoms and suicidal thoughts in the management of patients with bipolar disorder to improve health related outcomes and quality of life.


Asunto(s)
Trastorno Bipolar/psicología , Calidad de Vida , Adulto , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Ideación Suicida , Encuestas y Cuestionarios , Uganda
13.
J Stroke Cerebrovasc Dis ; 30(5): 105661, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33684710

RESUMEN

BACKGROUND AND PURPOSE: Stroke outcome data in Uganda is lacking. The objective of this study was to capture 30-day mortality outcomes in patients presenting with acute and subacute stroke to Mbarara Regional Referral Hospital (MRRH) in Uganda. METHODS: A prospective study enrolling consecutive adults presenting to MRRH with abrupt onset of focal neurologic deficits suspicious for stroke, from August 2014 to March 2015. All patients had head computed tomography (CT) confirmation of ischemic or hemorrhagic stroke. Data was collected on mortality, morbidity, risk factors, and imaging characteristics. RESULTS: Investigators screened 134 potential subjects and enrolled 108 patients. Sixty-two percent had ischemic and 38% hemorrhagic stroke. The mean age of all patients was 62.5 (SD 17.4), and 52% were female. More patients had hypertension in the hemorrhagic stroke group than in the ischemic stroke group (53% vs. 32%, p = 0.0376). Thirty-day mortality was 38.1% (p = 0.0472), and significant risk factors were National Institutes of Health Stroke Scale (NIHSS) score, female sex, anemia, and HIV infection. A one unit increase of the NIHSS on admission increased the risk of death at 30 days by 6%. Patients with hemorrhagic stroke had statistically higher NIHSS scores (p = 0.0408) on admission compared to patients with ischemic stroke, and also had statistically higher Modified Rankin Scale (mRS) scores at discharge (p = 0.0063), and mRS score change from baseline (p = 0.04). CONCLUSIONS: Our study highlights an overall 30-day stroke mortality of 38.1% in southwestern Uganda, and identifies NIHSS at admission, female sex, anemia, and HIV infection as predictors of mortality.


Asunto(s)
/mortalidad , /mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Anemia/mortalidad , Comorbilidad , Evaluación de la Discapacidad , Femenino , Infecciones por VIH/mortalidad , /terapia , Hospitalización , Humanos , /terapia , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Factores de Tiempo , Tomografía Computarizada por Rayos X , Uganda/epidemiología , Adulto Joven
14.
Zootaxa ; 4915(1): zootaxa.4915.1.10, 2021 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-33756590

RESUMEN

Nothobranchius elucens, new species, from a seasonal habitat in the Aringa system of the Achwa River in the upper Nile drainage in northern Uganda, is described. It belongs to the N. rubroreticulatus species group, whose members are characterised by male coloration of anal and caudal fins with slender light blue subdistal band and slender dark distal band. Nothobranchius elucens is distinguished from all other members of the genus by the following characters in males: body colouration golden-grey with brown scale margins creating irregular vertical stripes on trunk; anal fin yellow with brown spots proximally, with slender brown median band, followed by a slender light blue subdistal band and a slender black distal band; caudal fin brown proximally and medially, followed by a slender light blue subdistal band and a slender black distal band; dorsal fin golden with irregular brown stripes and narrow light blue subdistal band and with narrow black distal band. Furthermore, it differs from the closest known relative, N. taiti, also by the morphometric characters of having a smaller head length of 29.5-33.1 % SL; smaller prepectoral length of 31.2-33.9 % SL; greater head depth of 81-87 % HL; greater interorbital width of 43-49 % HL; and greater caudal peduncle length of 145-152 in % of its depth.


Asunto(s)
Ciprinodontiformes , Fundulidae , Animales , Drenaje , Masculino , Ríos , Estaciones del Año , Uganda
15.
Zootaxa ; 4926(4): zootaxa.4926.4.9, 2021 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-33756735

RESUMEN

Two species of Thubdora Park (T. onsemiro Park, sp. nov. and T. elgozmanyi Park, sp. nov.) and one species of Ptilothyris Walsingham (P. galbiplatella Park, sp. nov.) are described from Uganda.


Asunto(s)
Lepidópteros , Mariposas Nocturnas , Distribución Animal , Animales , Uganda
16.
Environ Monit Assess ; 193(4): 228, 2021 Mar 27.
Artículo en Inglés | MEDLINE | ID: mdl-33772658

RESUMEN

This study investigated the occurrence and seasonal variation in concentrations of emerging organic contaminants (EOCs) in shallow groundwater underlying two peri-urban areas of Bwaise (highly urbanised) and Wobulenzi (moderately urbanised) in Uganda. Twenty-six antibiotics, 20 hydrocarbons, including 16 polycyclic aromatic hydrocarbons (PAHs), and 59 pesticides were investigated. Ampicillin and benzylpenicillin were the most frequently detected antibiotics in both areas, although at low concentrations to cause direct harm to human health, but could lead to a proliferation of antibiotic resistance genes. The most frequently detected hydrocarbons in Bwaise were naphthalene and xylene while anthracene and fluoranthene were the most frequent in Wobulenzi, also at low concentrations for ecological impact at long-term exposure. Molecular diagnostic ratios indicated pyrogenic and pyrolytic sources of PAHs in both areas. Cypermethrin (for vermin control) was the most frequent pesticide in Bwaise while metalaxyl (attributed to agriculture) was the most frequent in Wobulenzi. Banned organochlorines (8) were also detected in both areas in low concentrations. The pesticide concentrations between the two areas significantly differed (Z = - 3.558; p < 0.01), attributed to contrasting land-use characteristics. In Wobulenzi (wet season), the total pesticide concentrations at all the locations exceeded the European Community parametric guideline value while 75% of the detected compounds exceeded the individual pesticide guideline value. Thus, the antibiotic and pesticide residues in shallow groundwater underlying both Bwaise and Wobulenzi pose potential adverse ecological effects at long-term exposure. Monitoring of EOCs in both highly and moderately urbanised catchments should be strengthened towards mitigating associated risks.


Asunto(s)
Agua Subterránea , Hidrocarburos Policíclicos Aromáticos , Contaminantes Químicos del Agua , Monitoreo del Ambiente , Humanos , Hidrocarburos Policíclicos Aromáticos/análisis , Uganda , Contaminantes Químicos del Agua/análisis
17.
Artículo en Inglés | MEDLINE | ID: mdl-33681934

RESUMEN

INTRODUCTION: Inadequate wastewater treatment and fecal contamination have a strong environmental impact on antimicrobial resistance (AMR). This study evaluated the profile of AMR enterobacteria and fecal contamination from four surface waters: Jiquiriça-Brejões River and Cabrito, Tororó, and Abaeté Lagoons. METHODS: We analyzed AMR ß-lactamase genes using the polymerase chain reaction method and fecal contamination using Coliscan®. RESULTS: We found high levels of fecal contamination, ß-lactamase producers, and AMR genes (blaOXA-48, blaSPM, and blaVIM) in all waterbodies. CONCLUSIONS: Poor sanitation evidenced by fecal contamination and human activities around these surface waters contributed to the distribution and increase in AMR enterobacteria.


Asunto(s)
Antiinfecciosos , Enterobacteriaceae , Enterobacteriaceae/genética , Heces , Humanos , Población Rural , Uganda
18.
Environ Sci Technol ; 55(8): 5463-5474, 2021 04 20.
Artículo en Inglés | MEDLINE | ID: mdl-33750111

RESUMEN

Decision-makers in developing communities often lack credible data to inform decisions related to water, sanitation, and hygiene. Quantitative microbial risk assessment (QMRA), which quantifies pathogen-related health risks across exposure routes, can be informative; however, the utility of QMRA for decision-making is often undermined by data gaps. This work integrates QMRA, uncertainty and sensitivity analyses, and household surveys in Bwaise, Kampala (Uganda) to characterize the implications of censored data management, identify sources of uncertainty, and incorporate risk perceptions to improve the suitability of QMRA for informal settlements or similar settings. In Bwaise, drinking water, hand rinse, and soil samples were collected from 45 households and supplemented with data from 844 surveys. Quantified pathogen (adenovirus, Campylobacter jejuni, and Shigella spp./EIEC) concentrations were used with QMRA to model infection risks from exposure through drinking water, hand-to-mouth contact, and soil ingestion. Health risks were most sensitive to pathogen data, hand-to-mouth contact frequency, and dose-response models (particularly C. jejuni). When managing censored data, results from upper limits of detection, half of limits of detection, and uniform distributions returned similar results, which deviated from lower limits of detection and maximum likelihood estimation imputation approaches. Finally, risk perceptions (e.g., it is unsafe to drink directly from a water source) were identified to inform risk management.


Asunto(s)
Saneamiento , Microbiología del Agua , Medición de Riesgo , Uganda , Incertidumbre
19.
Artículo en Inglés | MEDLINE | ID: mdl-33652873

RESUMEN

(1) Background: Teachers' personal and strenuous working conditions reflect the realities of the teaching vocation that may result in increased stress levels and associated negative consequences, such as negative emotions. It is also well-known that teacher stress contributes to more violence against students. However, little is known about personal and school context factors that contribute to teachers' stress. The current study examined whether, in addition to school-related factors, job perceptions, including the feeling of pressure at work and perceived school climate and teaching difficulties, contribute to teachers' stress. (2) Methods: A representative sample of 291 teachers from 12 public secondary schools in southwestern Uganda responded to self-administered questionnaires. (3) Results: Teaching difficulties and feelings of pressure at work contributed to teachers' stress. Furthermore, stress did not vary with teachers' sociodemographic variables. (4) Conclusions: Teachers' perceptions of their working conditions were associated with teacher stress levels. Therefore, more efforts need to be geared towards improving the working conditions of teachers as a way of reducing stress.


Asunto(s)
Maestros , Instituciones Académicas , Humanos , Percepción , Estudiantes , Uganda/epidemiología
20.
Environ Int ; 152: 106477, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33756429

RESUMEN

BACKGROUND: Multiple epidemiological studies have shown that exposure to single pesticide active ingredients or chemical groups is associated with adverse neurobehavioral outcomes in farmers. In agriculture, exposure to multiple pesticide active ingredients is the rule, rather than exception. Therefore, occupational studies on neurobehavioral effects of pesticides should account for potential co-exposure confounding. METHODS: We conducted a cross-sectional study of 288 Ugandan smallholder farmers between September and December 2017. We collected data on self-reported use of pesticide products during the 12 months prior to survey and estimated yearly exposure-intensity scores for 14 pesticide active ingredients using a semi-quantitative exposure algorithm. We administered 11 neurobehavioral tests to assess five neurobehavioral domains. We implemented a Bayesian Model-Averaging (BMA) approach to examine the association between exposure to multiple pesticides and neurobehavioral outcomes, while accounting for multiple testing. We applied two levels of inference to determine (1) which neurobehavioral outcomes were associated with overall pesticide exposure (marginal inclusion probability (MIP) for covariate-only models <0.5) and (2) which specific pesticide active ingredients were associated with these outcomes (MIP for models where active ingredient was included >0.5). RESULTS: Seventy-two percent of farmers reported use of pesticide products that contained at least one of 14 active ingredients, while the applicators used in median three different active ingredients (interquartile range (IQR) 4) in the 12 months prior to the study. The most widely used active ingredients were glyphosate (79%), cypermethrin (60%), and mancozeb (55%). We found that overall pesticide exposure was associated with impaired visual memory (Benton Visual Retention Test (BVRT)), language (semantic verbal fluency test), perceptual-motor function (Finger tapping test), and complex attention problems (Trail making A test and digit symbol test). However, when we looked at the associations for individual active ingredients, we only observed a positive association between glyphosate exposure and impaired visual memory (-0.103 [95% Bayesian Credible Interval (BCI)] [-0.24, 0] units in BVRT scores per interquartile range (IQR) increase in annual exposure to glyphosate, relative to a median [IQR] of 6 [3] units in BVRT across the entire study population). CONCLUSIONS: We found that overall pesticide exposure was associated with several neurobehavioral outcome variables. However, when we examined individual pesticide active ingredients, we observed predominantly null associations, except for a positive association between glyphosate exposure and impaired visual memory. Additional epidemiologic studies are needed to evaluate glyphosate's neurotoxicity, while accounting for co-pollutant confounding.


Asunto(s)
Exposición Profesional , Plaguicidas , Agricultura , Teorema de Bayes , Estudios Transversales , Agricultores , Humanos , Exposición Profesional/efectos adversos , Exposición Profesional/análisis , Plaguicidas/toxicidad , Uganda
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