Sudan virus disease super-spreading, Uganda, 2022.

BACKGROUND: On 20 September 2022, Uganda declared its fifth Sudan virus disease (SVD) outbreak, culminating in 142 confirmed and 22 probable cases. The reproductive rate (R) of this outbreak was 1.25. We described persons who were exposed to the virus, became infected, and they led to the infection of an unusually high number of cases during the outbreak. METHODS: In this descriptive cross-sectional study, we defined a super-spreader person (SSP) as any person with real-time polymerase chain reaction (RT-PCR) confirmed SVD linked to the infection of ≥ 13 other persons (10-fold the outbreak R). We reviewed illness narratives for SSPs collected through interviews. Whole-genome sequencing was used to support epidemiologic linkages between cases. RESULTS: Two SSPs (Patient A, a 33-year-old male, and Patient B, a 26-year-old male) were identified, and linked to the infection of one probable and 50 confirmed secondary cases. Both SSPs lived in the same parish and were likely infected by a single ill healthcare worker in early October while receiving healthcare. Both sought treatment at multiple health facilities, but neither was ever isolated at an Ebola Treatment Unit (ETU). In total, 18 secondary cases (17 confirmed, one probable), including three deaths (17%), were linked to Patient A; 33 secondary cases (all confirmed), including 14 (42%) deaths, were linked to Patient B. Secondary cases linked to Patient A included family members, neighbours, and contacts at health facilities, including healthcare workers. Those linked to Patient B included healthcare workers, friends, and family members who interacted with him throughout his illness, prayed over him while he was nearing death, or exhumed his body. Intensive community engagement and awareness-building were initiated based on narratives collected about patients A and B; 49 (96%) of the secondary cases were isolated in an ETU, a median of three days after onset. Only nine tertiary cases were linked to the 51 secondary cases. Sequencing suggested plausible direct transmission from the SSPs to 37 of 39 secondary cases with sequence data. CONCLUSION: Extended time in the community while ill, social interactions, cross-district travel for treatment, and religious practices contributed to SVD super-spreading. Intensive community engagement and awareness may have reduced the number of tertiary infections. Intensive follow-up of contacts of case-patients may help reduce the impact of super-spreading events.

Time to care and factors influencing appropriate Sudan virus disease care among case patients in Uganda, September to November 2022.

OBJECTIVES: Early isolation and care for Ebola disease patients at Ebola Treatment Units (ETU) curb outbreak spread. We evaluated time to ETU entry and associated factors during the 2022 Sudan virus disease (SVD) outbreak in Uganda. METHODS: We included persons with RT-PCR-confirmed SVD with onset September 20-November 30, 2022. We categorized days from symptom onset to ETU entry ("delays") as short (≤2), moderate (3-5), and long (≥6); the latter two were "delayed isolation." We categorized symptom onset timing as "earlier" or "later," using October 15 as a cut-off. We assessed demographics, symptom onset timing, and awareness of contact status as predictors for delayed isolation. We explored reasons for early vs late isolation using key informant interviews. RESULTS: Among 118 case-patients, 25 (21%) had short, 43 (36%) moderate, and 50 (43%) long delays. Seventy-five (64%) had symptom onset later in the outbreak. Earlier symptom onset increased risk of delayed isolation (crude risk ratio = 1.8, 95% confidence interval (1.2-2.8]). Awareness of contact status and SVD symptoms, and belief that early treatment-seeking was lifesaving facilitated early care-seeking. Patients with long delays reported fear of ETUs and lack of transport as contributors. CONCLUSION: Delayed isolation was common early in the outbreak. Strong contact tracing and community engagement could expedite presentation to ETUs.

Trends and geospatial distribution of stillbirths in Uganda, 2014-2020.

INTRODUCTION: Uganda with 17.8 stillbirths per 1,000 deliveries in 2021, is among the countries with a high burden of stillbirths globally. In 2014, Uganda adopted the World Health Organization Every New-born Action Plan (ENAP), which targets < 10 stillbirths per 1,000 deliveries by 2035. Little is known about the trends of stillbirth burden since ENAP was introduced. We assessed the temporal, and spatial distribution of stillbirths, in Uganda, 2014-2020, to inform programming for safe pregnancies and deliveries. METHODS: We obtained and analysed stillbirth surveillance data from the District Health Information System, 2014-2020. A stillbirth was defined as the death of a foetus > 28 weeks of pregnancy or weighing > 1000 g before or during birth and reported to a health facility. We calculated annual incidence rates of stillbirths per 1,000 deliveries at district, regional, and national levels. We used logistic regression to determine the significance of trends. RESULTS: The overall national annual incidence of stillbirths decreased from 24/1,000 deliveries in 2014 to 17/1,000 deliveries in 2020. During the same period, reporting rates declined from 71% in 2014 to 46% in 2020. The central region continuously had the highest incidence rate for the past 5 years despite the largest decline (OR = 0.79; CI = 0.77-0.83, P < 0.001) while the eastern region had the smallest decline (OR = 0.59; CI = 0.57-0.61, P < 0.001). Districts with persistently high annual incidence rates of stillbirths (> 30/1000) included Mubende, Kalangala, Hoima, and Nebbi. There was no difference in the reporting rates of the most- vs. least-affected districts. CONCLUSION: Even with suboptimal reporting, the incidence of stillbirths remained above the national target. Specific areas in the country appear to have particularly high stillbirth rates. We recommend continuous capacity building in managing pregnant women with an emphasis on the most affected districts, and investigation into the reasons for low reporting.

Ebola incidence and mortality before and during a lockdown: The 2022 epidemic in Uganda.

On September 20, 2022, an Ebola Disease (EBOD) outbreak was declared in Mubende district, Central Uganda. Following a rapid surge in the number of cases and mortality, the Government of Uganda imposed a lockdown in the two most affected districts, Mubende and Kassanda. We describe the trends in EBOD incidence and mortality nationally and in the two districts before and during the lockdown and the lessons learned during the epidemic response. We retrieved data from the Ministry of Health situation reports from September 20, 2022, when the EBOD outbreak was declared until November 26, 2022, when the lockdown ended. We graphed trends in EBOD morbidity and mortality during a 3-week and 6-week lockdown, computed the EBOD case fatality rate, and summarized the major lessons learned during the epidemic response. We found case fatality rate during the pre-lockdown, 3-week lockdown, and 6-week lockdown period was 37.9% (22/58), 39.3% (53/135), and 38.7% (55/142), respectively. In the early weeks of the lockdown, EBOD incidence and mortality increased nationally and in Kassanda district while Mubende district registered a decline in incidence and stagnation in mortality. With the extension of the lockdown to six weeks, the EBOD incidence and mortality during the 4-6-week lockdown declined compared to the pre-lockdown period. In conclusion, the EBOD incidence and mortality remained higher in the early weeks of the lockdown than during the pre-lockdown period nationally and in one of the two districts. With extended lockdown, incidence and mortality dropped in the 4-6-week period than the pre-lockdown period. Therefore, reliance on known public health measures to control an EBOD outbreak is important.

Trends and spatial distribution of neonatal sepsis, Uganda, 2016-2020.

BACKGROUND: In Uganda, sepsis is the third-leading cause of neonatal deaths. Neonatal sepsis can be early-onset sepsis (EOS), which occurs ≤ 7 days postpartum and is usually vertically transmitted from the mother to newborn during the intrapartum period, or late-onset sepsis (LOS), occurring 8-28 days postpartum and largely acquired from the hospital environment or community. We described trends and spatial distribution of neonatal sepsis in Uganda, 2016-2020. METHODS: We conducted a descriptive incidence study using routinely-reported surveillance data on in-patient neonatal sepsis from the District Health Information System version 2 (DHIS2) during 2016-2020. We calculated incidence of EOS, LOS, and total sepsis as cases per 1,000 live births (LB) at district (n = 136), regional (n = 4), and national levels, as well as total sepsis incidence by health facility level. We used logistic regression to evaluate national and regional trends and illustrated spatial distribution using choropleth maps. RESULTS: During 2016-2020, 95,983 neonatal sepsis cases were reported, of which 71,262 (74%) were EOS. Overall neonatal sepsis incidence was 17.4/1,000 LB. EOS increased from 11.7 to 13.4 cases/1,000 LB with an average yearly increase of 3% (p < 0.001); LOS declined from 5.7 to 4.3 cases/1,000 LB with an average yearly decrease of 7% (p < 0.001). Incidence was highest at referral hospitals (68/1,000 LB) and lowest at Health Center IIs (1.3/1,000 LB). Regionally, total sepsis increased in Central (15.5 to 23.0/1,000 LB, p < 0.001) and Northern regions (15.3 to 22.2/1,000 LB, p < 0.001) but decreased in Western (23.7 to 17.0/ 1,000 LB, p < 0.001) and Eastern (15.0 to 8.9/1,000, p < 0.001) regions. CONCLUSION: The high and increasing incidence of EOS in Uganda suggests a major gap in sepsis prevention and quality of care for pregnant women. The heterogenous distribution of neonatal sepsis incidence requires root cause analysis by health authorities in regions with consistently high incidence. Strengthening prevention and treatment interventions in Central and Northern regions, and in the most affected districts, could reduce neonatal sepsis. Employment of strategies which increase uptake of safe newborn care practices and prevent neonatal sepsis, such as community health worker (CHW) home visits for mothers and newborns, could reduce incidence.

Determinants of male involvement in antenatal care at Palabek Refugee Settlement, Lamwo district, Northern Uganda.

BACKGROUND: In 2014, Uganda launched the National Male Involvement Strategy in Maternal and Child Health. In 2020, the District Health Management Information System report for Lamwo district, where Palabek Refugee Settlement is located, indicated a 10% male involvement in antenatal care (ANC) at the settlement. We investigated determinants of male involvement in ANC in Palabek Refugee Settlement to inform programs on improvement of male involvement in ANC in a refugee setting. METHODOLOGY: We conducted a community-based cross-sectional analytical study among a proportionate sample of mothers in Palabek Refugee Settlement from October-December 2021. Using a standardized questionnaire, we collected information on demographics and the constructs of the socio-ecological model where consent was given. We summarized data in tables and figures. We used Pearson chi-square test to determine significance of independent variables at bivariate level. A multivariable logistic regression model was run for all variables found significant at bivariate analysis to determine association between the different independent variables and male involvement in ANC. RESULTS: We interviewed 423 mothers. The mean age of their male partners was 31 years, SD 7. 81% (343/423) of male partners had formal education, with 13% (55/423) having a source of income and 61% (257/423) having access to ANC information during their pregnancy. The level of male involvement in ANC in Palabek Refugee Settlement was 39% (164/423). Male involvement in ANC was positively associated with access to information on ANC (AOR 3.0; 95%Cl: 1.7-5.4) and frequent couple discussion on ANC (AOR 10.1; 95%Cl: 5.6-18.0). However, it was negatively associated with distance ≥ 3 km to the health facility (AOR 0.6 ;95%Cl: 0.4-1.0). CONCLUSIONS: Approximately one in three male partners in Palabek Refugee Settlement were involved in ANC. Male partners who had access to information during ANC and those who had frequent discussions were more likely to get involved in ANC. Men who lived ≥ 3 km from the health facility were less likely to be involved in ANC. We recommend intensified awareness creation on importance of male involvement in ANC and implementation of integrated community outreaches to reduce distance to the health facility.

Community dialogue meetings among district leaders improved their willingness to receive COVID-19 vaccines in Western Uganda, May 2021.

BACKGROUND: Widespread COVID-19 vaccine uptake can facilitate epidemic control. A February 2021 study in Uganda suggested that public vaccine uptake would follow uptake among leaders. In May 2021, Baylor Uganda led community dialogue meetings with district leaders from Western Uganda to promote vaccine uptake. We assessed the effect of these meetings on the leaders' COVID-19 risk perception, vaccine concerns, perception of vaccine benefits and access, and willingness to receive COVID-19 vaccine. METHODS: All departmental district leaders in the 17 districts in Western Uganda, were invited to the meetings, which lasted approximately four hours. Printed reference materials about COVID-19 and COVID-19 vaccines were provided to attendees at the start of the meetings. The same topics were discussed in all meetings. Before and after the meetings, leaders completed self-administered questionnaires with questions on a five-point Likert Scale about risk perception, vaccine concerns, perceived vaccine benefits, vaccine access, and willingness to receive the vaccine. We analyzed the findings using Wilcoxon's signed-rank test. RESULTS: Among 268 attendees, 164 (61%) completed the pre- and post-meeting questionnaires, 56 (21%) declined to complete the questionnaires due to time constraints and 48 (18%) were already vaccinated. Among the 164, the median COVID-19 risk perception scores changed from 3 (neutral) pre-meeting to 5 (strong agreement with being at high risk) post-meeting (p < 0.001). Vaccine concern scores reduced, with medians changing from 4 (worried about vaccine side effects) pre-meeting to 2 (not worried) post-meeting (p < 0.001). Median scores regarding perceived COVID-19 vaccine benefits changed from 3 (neutral) pre-meeting to 5 (very beneficial) post-meeting (p < 0.001). The median scores for perceived vaccine access increased from 3 (neutral) pre-meeting to 5 (very accessible) post-meeting (p < 0.001). The median scores for willingness to receive the vaccine changed from 3 (neutral) pre-meeting to 5 (strong willingness) post-meeting (p < 0.001). CONCLUSION: COVID-19 dialogue meetings led to district leaders' increased risk perception, reduced concerns, and improvement in perceived vaccine benefits, vaccine access, and willingness to receive the COVID-19 vaccine. These could potentially influence public vaccine uptake if leaders are vaccinated publicly as a result. Broader use of such meetings with leaders could increase vaccine uptake among themselves and the community.

Readiness of health facilities to manage individuals infected with COVID-19, Uganda, June 2021.

BACKGROUND: The COVID-19 pandemic overwhelmed the capacity of health facilities globally, emphasizing the need for readiness to respond to rapid increases in cases. The first wave of COVID-19 in Uganda peaked in late 2020 and demonstrated challenges with facility readiness to manage cases. The second wave began in May 2021. In June 2021, we assessed the readiness of health facilities in Uganda to manage the second wave of COVID-19. METHODS: Referral hospitals managed severe COVID-19 patients, while lower-level health facilities screened, isolated, and managed mild cases. We assessed 17 of 20 referral hospitals in Uganda and 71 of 3,107 lower-level health facilities, selected using multistage sampling. We interviewed health facility heads in person about case management, coordination and communication and reporting, and preparation for the surge of COVID-19 during first and the start of the second waves of COVID-19, inspected COVID-19 treatment units (CTUs) and other service delivery points. We used an observational checklist to evaluate capacity in infection prevention, medicines, personal protective equipment (PPE), and CTU surge capacity. We used the "ReadyScore" criteria to classify readiness levels as > 80% ('ready'), 40-80% ('work to do'), and < 40% ('not ready') and tailored the assessments to the health facility level. Scores for the lower-level health facilities were weighted to approximate representativeness for their health facility type in Uganda. RESULTS: The median (interquartile range (IQR)) readiness scores were: 39% (IQR: 30, 51%) for all health facilities, 63% (IQR: 56, 75%) for referral hospitals, and 32% (IQR: 24, 37%) for lower-level facilities. Of 17 referral facilities, two (12%) were 'ready' and 15 (88%) were in the "work to do" category. Fourteen (82%) had an inadequate supply of medicines, 12 (71%) lacked adequate supply of oxygen, and 11 (65%) lacked space to expand their CTU. Fifty-five (77%) lower-level health facilities were "not ready," and 16 (23%) were in the "work to do" category. Seventy (99%) lower-level health facilities lacked medicines, 65 (92%) lacked PPE, and 53 (73%) lacked an emergency plan for COVID-19. CONCLUSION: Few health facilities were ready to manage the second wave of COVID-19 in Uganda during June 2021. Significant gaps existed for essential medicines, PPE, oxygen, and space to expand CTUs. The Uganda Ministry of Health utilized our findings to set up additional COVID-19 wards in hospitals and deliver medicines and PPE to referral hospitals. Adequate readiness for future waves of COVID-19 requires additional support and action in Uganda.

Ownership and use of long-lasting insecticidal nets three months after a mass distribution campaign in Uganda, 2021.

BACKGROUND: Uganda conducted its third mass long-lasting insecticidal net (LLIN) distribution campaign in 2021. The target of the campaign was to ensure that 100% of households own at least one LLIN per two persons and to achieve 85% use of distributed LLINs. LLIN ownership, use and associated factors were assessed 3 months after the campaign. METHODS: A cross-sectional household survey was conducted in 14 districts from 13 to 30 April, 2021. Households were selected using multistage sampling. Each was asked about LLIN ownership, use, duration since received to the time of interview, and the presence of LLINs was visually verified. Outcomes were having at least one LLIN per two household members, and individual LLIN use. Modified Poisson regression was used to assess associations between exposures and outcomes. RESULTS: In total, 5529 households with 27,585 residents and 15,426 LLINs were included in the analysis. Overall, 95% of households owned ≥ 1 LLIN, 92% of the households owned ≥ 1 LLIN < 3 months old, 64% of households owned ≥ 1 LLIN per two persons in the household. Eighty-seven per cent could sleep under an LLIN if every LLIN in the household were used by two people, but only 69% slept under an LLIN the night before the survey. Factors associated with LLIN ownership included believing that LLINs are protective against malaria (aPR = 1.13; 95% CI 1.04-1.24). Reported use of mosquito repellents was negatively associated with ownership of LLINs (aPR = 0.96; 95% CI 0.95-0.98). The prevalence of LLIN use was 9% higher among persons who had LLINs 3-12 months old (aPR = 1.09; 95% CI 1.06-1.11) and 10% higher among those who had LLINs 13-24 months old (aPR = 1.10; 95% CI 1.06-1.14) than those who had LLINs < 3 months old. Of 3,859 LLINs identified in the households but not used for sleeping the previous night, 3250 (84%) were < 3 months old. Among these 3250, 41% were not used because owners were using old LLINs; 16% were not used because of lack of space for hanging them; 11% were not used because of fear of chemicals in the net; 5% were not used because of dislike of the smell of the nets; and, 27% were not used for other reasons. CONCLUSION: The substantial difference between the population that had access to LLINs and the population that slept under LLINs indicates that the National Malaria Control Programme (NMCP) may need to focus on addressing the main drivers or barriers to LLIN use. NMCP and/or other stakeholders could consider designing and conducting targeted behaviour change communication during subsequent mass distribution of LLINs after the mass distribution campaign to counter misconceptions about new LLINs.

Biofuel characteristics of non-charred briquettes from dried fecal sludge blended with food market waste: Suggesting a waste-to-biofuel enterprise as a win-win strategy to solve energy and sanitation problems in slums settlements.

This study explored the production and evaluation of briquettes made from dried fecal sludge mixed with fresh food waste as a dual strategy to solve energy poverty and poor sanitation problems in Ugandan slums. Cylindrical briquettes measuring 82 mm height by 76 mm diameter were produced from dried fecal sludge (FS) alone, and FS mixed separately with pineapple peels (FS + PP), charcoal fines (FS + CD), and bean husks (FS + BH) in a mix ratio of 50% FS: 50% biomass (wt/wt basis) using red soil as the binder. Physiochemical characteristics and fuel thermal efficiency of the briquettes were tested following ASTM standards and were compared to wood-derived charcoal and commonly traded briquettes on market in Uganda. The average moisture content was 5.1%. Bulk density was highest in FS briquettes (1.12 g/cm3) and lowest in FS + BH (0.847 g/cm3). Volatile matter (VM) was highest in FS + PP (39%) and lowest in FS alone (25.7%). The average ash content was 30.4%. FS + PP had the highest calorific value (17.92 MJ/kg) while FS alone had the lowest (6.19 MJ/kg). The highest burning rate was recorded in FS + CD briquettes (8 g/min) and was lowest in FS + PP (4 g/min). Based on the calculated burning rates and calorific values, the economic advantage calculations implied that blending one ton of dry FS with one ton of dry pineapple peels for fuel briquettes, and their use as a substitute could save consumers about USD 620 per ton of wood charcoal foregone.

Nutrient recovery from pineapple waste through controlled batch and continuous vermicomposting systems.

The largest portion of pineapple peels and pulp generated from production points is disposed of haphazardly contributing to a number of environmental and health challenges. However, these wastes contain valuable plant nutrients that could be recovered to boost soil fertility, and increase agricultural production. This study evaluated the variation in physico-chemical parameters in batch and continuous vermicomposting systems as potential pathways for nutrient recovery from pineapple waste. The study compared the efficiency of waste reduction and nutrient recovery for batch (B), and continuous (C) vermicomposting systems during a 60-day period. The substrates were pineapple peels (PW), and cattle manure (CM) fed in a ratio of 4:1 (w/w). Control reactors were fed with 100% CM in both the feeding modes. Results indicated that waste degradation was 60%, and 54% while earthworm biomass increased by 57% and 129% for BPW, and CPW, respectively. pH significantly decreased with time in both systems. Total phosphorous increased with vermicomposting time with that of B being significantly higher than C systems. Nitrogen, potassium, and sodium significantly increased in the control experiments while the three elements significantly reduced for BPW, and CPW owing to high leachate production in the latter. The N, P, K, and C retention in vermicompost was 24.2%, 90.4%, 67.5%, 41.1%, and 32.6%, 91.2%, 79.3%, 46.1%, for BPW and CPW, respectively. Continuous systems produced higher earthworm biomass and retained more nutrients in vermicompost than batch systems, and can therefore, be recommended as better systems for pineapple waste vermicomposting.

Pharmaceutical pollution of water resources in Nakivubo wetlands and Lake Victoria, Kampala, Uganda.

This study investigated the occurrence and removal in wastewater and water bodies in Nakivubo wetland area and Inner Murchison Bay, Lake Victoria, of common prescription and non-prescription pharmaceutically-active substances (PhACs) sold in Kampala city, Uganda. A questionnaire was sent to 20 pharmacies in Kampala, to identify the most commonly sold PhACs in the city. During two sampling campaigns, samples were collected from Bugolobi wastewater treatment plant (WWTP) influent and effluent and surface water samples from Nakivubo channel, Nakivubo wetland and Inner Murchison Bay. The concentrations of 28 PhACs, organic matter, solids and nutrients in water samples were analysed. Ciprofloxacin (antibiotic), cetirizine (anti-allergy), metformin (anti-diabetes), metronidazole (antibiotic) and omeprazole (gastric therapy) were reported by pharmacies to be the PhACs most commonly sold in the study area. Chemical analysis of water samples revealed that trimethoprim (antibiotic) and sulfamethoxazole (antibiotic) were the dominant PhACs in water from all sites except Lake Victoria. Other PhACs such as atenolol (anti-hypertensive), carbamazepine (anti-epileptic) and diclofenac (anti-inflammatory) were also found at all study sites except Lake Victoria. ∑PhACs in effluent from Bugolobi WWTP (13000-37,600 ng L-1) was higher than in the corresponding influent (4000-28,000 ng L-1), indicating poor removal of PhACs within the WWTP. ∑PhACs decreased by a factor of 2-6 between Bugolobi WWTP effluent and Nakivubo channel (5700 ng L-1), due to dilution and sorption to channel sediment, and by a factor of 1-3 between the Nakivubo channel and Nakivubo wetland (3900-5400 ng L-1), due to sorption to sediment and uptake by plants in the wetland. No detectable levels of PhACs were found in water from Lake Victoria. Overall, this investigation demonstrated that PhACs in wastewater enter Nakivubo water system. Thus, Bugolobi WWTP needs to be upgraded to improve PhACs removal from wastewater. Considering the high occurrence of antibiotics in the water system in Kampala, development and spread of antimicrobial resistance within the area should also be investigated.

Per- and polyfluoroalkyl substances (PFASs) in water, soil and plants in wetlands and agricultural areas in Kampala, Uganda.

Occurrence and concentrations of 26 per- and polyfluoroalkyl substances (PFASs) were evaluated in wastewater, surface water, soil and crop plants (yam (Dioscorea spp.), maize (Zea mays) and sugarcane (Saccharum officinarum)) in Nakivubo wetland and Lake Victoria at Kampala, Uganda. ∑PFAS concentrations in effluent from Bugolobi wastewater treatment plant (WWTP) were higher (5.6-9.1ngL-1) than in the corresponding influent (3.4-5.1ngL-1), indicating poor removal of PFASs within the WWTP. ∑PFAS concentrations decreased by a factor of approximately five between Nakivubo channel (8.5-12ngL-1) and Lake Victoria (1.0-2.5ngL-1), due to dilution, sorption to sediment and uptake by plants in the wetland. ∑PFAS concentrations were within the range 1700-7900pgg-1 dry weight (dw) in soil and 160pgg-1 dw (maize cobs) to 380pgg-1 dw (sugarcane stems) in plants. The dominant PFASs were perfluorohexanesulfonate (PFHxS) in wastewater, perfluorooctanoate (PFOA) in surface water, perfluorooctanesulfonate (PFOS) in soil and perfluoroheptanoate (PFHpA) and PFOA in different plant tissues, reflecting PFAS-specific partitioning behaviour in different matrices. Soil-water partitioning coefficient (log Kd) in wetland soil under yam was lowest for short-chain PFHxA (1.9-2.3Lkg-1) and increased with increasing chain length to 2.8-3.1Lkg-1 for perfluoroundecanoate (PFUnDA) and 2.8-3.1Lkg-1 for perfluoroctanesulfonate (PFOS). The log Koc values ranged between 2.2 and 3.6Lkg-1, with the highest log Koc estimated for long-chain perfluorocarbon PFASs (i.e. PFUnDA 3.2-3.5Lkg-1 and PFOS 3.2-3.6Lkg-1). The concentration ratio (CR) between plants and soil was <1 for all PFASs and plant species, with the highest CR estimated for PFHpA (0.65-0.67) in sugarcane stem and PFBS (0.53-0.59) in yam root. Overall, this investigation demonstrated PFASs entry into the terrestrial food chain and drinking water resources in Kampala, Uganda. Source identification, assessment of impacts on human health and the environment, and better wastewater treatment technologies are needed.

A metagenomic analysis displays the diverse microbial community of a vermicomposting system in Uganda.

BACKGROUND: Vermicomposting is a mesophilic process using earthworms to efficiently and at low cost process large volumes of organic waste. It has been suggested to not only increase soil fertility but also increase biomass of beneficial bacteria while reducing harmful bacteria. The aim of this study was to set up a strategy to investigate and characterise the viral as well as the bacterial composition of a vermicomposting system. MATERIAL AND METHODS: The vermicomposting unit used in this study was placed at the Makerere University Agricultural Research Institute Kabanyolo on the outskirts of Kampala, Uganda, and was fed with 80% cattle manure and 20% food waste. On Day 172, the compost was terminated and compost samples were collected from three layers of the unit: the top, the middle and the bottom layer. A metagenomic approach was then applied to characterise the viral and bacterial composition of the vermicomposting system. RESULTS AND DISCUSSION: A high abundance and diversity of bacteria were identified. Proteobacteria was the largest phyla in the compost (mainly Alpha-, Gamma- and Betaproteobacteria), constituting almost 65% of the bacterial reads in the data sets. DNA samples from several possible pathogenic bacteria, such as Salmonella spp., Escherichia coli, Enterobacter spp., Enterococcus spp. and Clostridium spp, were detected in the vermicompost, suggesting that there might still be harmful bacteria in the vermicast. Phages constituted the main viral group; apart from phages, mainly insect viruses were identified. The only animal or human virus identified was kobuvirus. In summary, metagenomic analysis was shown to be an efficient technology to characterise the microbial composition of vermicast. The data from this study contribute to a better understanding of the microbes present in this kind of composting system and can help determine measures necessary for safe manure handling.

Mapping out the solid waste generation and collection models: The case of Kampala City.

This paper presents a mapping of the waste collection systems in Kampala city, using geographical information system (GIS) ArcGIS mapping software. It discusses the existing models of waste collection to the final disposal destinations. It was found that food and yard wastes constitute 92.7% of the waste generated in Kampala. Recyclables and other special wastes constitute only 7.3% of the total waste, mainly because of the increased level of reuse and recycling activities. The generation rate of solid wastes was on average, 582, 169, 105, and 90 tons/day from poor areas, upscale wealthier areas, business centers, and market areas respectively. This tonnage of waste was collected, transported, and disposed of at the city landfill. The study found that in total, residential areas of poor people generate more waste than other categories stated earlier, mainly because of their large populations. In total, there were 133 unofficial temporary storage sites acknowledged by Kampala Capital City Authority (KCCA) but not formally designated, 59 illegal dump sites, and 35 officially recognized temporary waste storage locations. This paper presents large-scale data that can help with understanding the collection models and their influence on solid waste management in Kampala city, which could be used for similar cities in developing countries.

Vermicomposting as manure management strategy for urban small-holder animal farms - Kampala case study.

Inadequate organic waste management can contribute to the spread of diseases and have negative impacts on the environment. Vermicomposting organic waste could have dual beneficial effects by generating an economically viable animal feed protein in the form of worm biomass, while alleviating the negative effects of poor organic waste management. In this study, a low-maintenance vermicomposting system was evaluated as manure and food waste management system for small-holder farmers. A vermicomposting system using the earthworm species Eudrilus eugeniae and treating cow manure and food waste was set up in Kampala, Uganda, and monitored for 172days. The material degradation and protein production rates were evaluated after 63days and at the end of the experiment. The material reduction was 45.9% and the waste-to-biomass conversion rate was 3.5% in the vermicomposting process on a total solids basis. A possible increase in the conversion rate could be achieved by increasing the frequency of worm harvesting. Vermicomposting was found to be a viable manure management method in small-scale urban animal agriculture; the return of investment was calculated to be 280% for treating the manure of a 450kg cow. The vermicompost was not sanitised, although hygiene quality could be improved by introducing a post-stabilisation step in which no fresh material is added. The value of the animal feed protein generated in the process can act as an incentive to improve current manure management strategies.

Characterization of municipal waste in Kampala, Uganda.

UNLABELLED: In Kampala, Uganda, about 28,000 tons of waste is collected and delivered to a landfill every month. Kampala Capital City Authority (KCCA) records show that this represents approximately 40% of the waste generated in the city. The remaining uncollected waste is normally dumped in unauthorized sites, causing health and environmental problems. However, the organic fraction of domestic waste can provide an opportunity to improve livelihoods and incomes through fertilizer and energy production. This study characterized the municipal waste generated in Kampala and delivered to Kiteezi landfill between July 2011 and June 2012, that is, covering the dry and wet months. On each sampling day, waste was randomly selected from five trucks, sorted and weighed into different physical fractions. Samples of the organic waste from each truck were analyzed for total solids, major nutrients, and energy content. During the wet months, the waste consisted of 88.5% organics, 3.8% soft plastics, 2.8% hard plastics, 2.2% paper, 0.9% glass, 0.7% textiles and leather 0.2% metals, and 1.0% others. During the dry months, the waste consisted of 94.8% organics, 2.4% soft plastics, 1.0% hard plastics, 0.7% papers, 0.3% glass, 0.3% textile and leather, 0.1% metals, and 0.3% others. The organic waste on average had a moisture content of 71.1% and contained 1.89% nitrogen, 0.27% phosphorus, and 1.95% potassium. The waste had an average gross energy content of 17.3 MJ/kg. It was concluded that the organic waste generated can be a suitable source of some plant nutrients that are useful especially in urban agriculture. IMPLICATIONS: The result of the waste characterization in Kampala was found to be significantly different from that obtained for other Sub-Saharan African (SSA) cities, showing that studies assuming average values for the waste fractions are likely to result in erroneous results. Furthermore, no reduction in organic fraction of the waste was noticed when compared with a study done two decades ago in spite of greatly improved economic status of Kampala city, a finding that is not in agreement with several other similar studies done for other SSA cities.