Intestinal schistosomiasis among preschool children along the shores of Lake Victoria in Uganda.

Schistosomiasis, a disease caused by Schistosoma trematode parasites, affects hundreds of millions of people and accounts for more than 40% of the global health burden due to neglected tropical diseases. In Uganda, intestinal schistosomiasis is endemic in 73 out of 112 districts and about 55% of the population of 36 million individuals are at risk. There is scanty information on the status and burden of schistosomiasis in preschool children less than six years of age in Uganda. This study aimed to assess the status of Schistosoma mansoni infections in children aged 1-5 years in Uganda. S. mansoni prevalence and intensity of infection were examined in 3058 children from 5 districts along Lake Victoria shoreline, eastern Uganda. For each child one stool sample was collected on three consecutive days. The Kato-Katz technique was used to prepare stool smears on slides for microscopic examination. Short interviews with a standardized pre-tested questionnaire prepared in the local language (Lusoga) were administered to each caregiver to identify risk factors associated with S. mansoni infection. An overall S. mansoni prevalence of 39.3% (95% CI: 38.0-41.1%) was estimated out of the 3058 stool samples examined. The geometric mean intensity of S. mansoni among the infected children was 273 (95% CI: 241-305) eggs per gram of faeces. Both prevalence and intensity of infection increased linearly with age (P<0.0001) and were highest in the age group 49-60 months. Majority (61%) of the children, especially in the age group 12-24 months (84.2%; 95% CI: 75.6-90.1%), were lightly infected. Short interviews with caregivers revealed that preschool children, 1-5 years old, get exposed to S. mansoni infested waters through bathing, playing or swimming. It is important that the Uganda national control programme for schistosomiasis takes preschool children into consideration and that health education on transmission of schistosomiasis is delivered to the endemic communities regularly.

Adherence to treatment and supervision for tuberculosis in a DOTS programme among pastoralists in Uganda.

OBJECTIVE: To estimate the levels of adherence to anti-tuberculosis medications and associated risk factors in a pastoral community practising transhumance in North-Eastern Uganda. DESIGN: A cross-sectional retrospective study of a cohort of tuberculosis (TB) patients and their community volunteers registered from August 2008 to July 2009. Self-reported data were collected on doses missed, doses not supervised, sociodemographic situation, drug availability, perceived drug side effects and use of the directly observed treatment (DOT) card. Medication adherence was defined as having ingested at least 90% of doses given, and supervision adherence was defined as direct observation of at least 90% of doses ingested. Independent predictors of medication adherence were identified using binary and multivariate logistic regression. RESULTS: A total of 126 TB patients and an equal number of community volunteers were enrolled in the study. Medication and supervision adherence were estimated at respectively 72% and 63%. Independent predictors of medication adherence were perceived drug side effects (adjusted odds ratio [aOR] 5.0, 95%CI 1.86-13.6), running out of drugs (aOR 5.97, 95%CI 2.27-15.70) and DOT card not filled in (aOR 6.65, 95%CI 2.08-20.66). CONCLUSION: Adherence among pastoralists is less than optimal due to poor institutionalisation of the DOTS strategy in a pastoralist community.

Cost effectiveness of facility and home based HIV voluntary counseling and testing strategies in rural Uganda.

BACKGROUND: In Uganda, the main stay for provision of human immunodeficiency virus (HIV) voluntary counseling and testing (VCT) has been at health facilities. Home based VCT on the other hand, was initiated in the country to improve service coverage. OBJECTIVE: To evaluate the cost effectiveness of facility- and home-based HIV VCT strategies in rural southwestern Uganda. METHODS: Data on costs and effectiveness of facility- and home-based HIV VCT intervention strategies was collected in two sub-Counties in rural southwestern Uganda. Costing was performed using the ingredients approach. Effectiveness was measured as the number of HIV sero-positive clients identified. Incremental Cost-Effectiveness Ratios (ICERs) were calculated from the provider perspective. RESULTS: The cost per client tested were US$6.4 for facility based VCT and US$5.0 for home based VCT. The corresponding costs per positive case identified were US$86.5 and US$54.7 respectively. The incremental cost to providers per additional positive case identified by facility based VCT was US$3.5. CONCLUSION: Home based VCT was the least costly strategy per client tested and was also cost effective in identifying HIV sero-positive clients in rural areas. This strategy should therefore be promoted to improve service coverage and thereby facilitate early and extensive detection of clients eligible for treatment.

Sexual behaviour among persons living with HIV/AIDS in Kampala, Uganda.

OBJECTIVE: To identify sexual behaviour and reproductive health needs of people living with HIV/AIDS (PLWHAs). DESIGN: A cross sectional study. SETTING: Joint Clinical Research Centre, Kampala Uganda. PARTICIPANTS: Three hundred and eighty PLWHAs, 50% of whom had initiated anti-retro viral therapy (ART). MAIN OUTCOME MEASURES: PLWHAs answered questions regarding sexual behaviour, number and type of sexual partners, symptoms of sexually transmitted infections, having been pregnant or causing a pregnancy, social demographic characteristics, consumption of alcohol, having biological children, desire for more children and use of condoms. RESULTS: In the past 12 months 227 (60%) of the PLWHAs were sexually active. Of the sexually active 42 (19%) never used a condom, and 92 (40%) used condoms inconsistently, thus 134 (35%) of PLWHAs engaged in high risk sex. Two hundred and sixty five (70%) said that PLWHAs can have healthy children and 115 (30%) desired more children with 21 (10%) of the women in the reproductive age group reporting a pregnancy and 22 (17%) of the men reporting having caused a pregnancy. Only three (7%) of the pregnancies were unplanned. Desire for more children was a strong independent predictor of engaging in high risk sex (Adjusted Odds Ratio 2.44, 95% CI 1.35-4.42). CONCLUSIONS: This study demonstrates that abstinence and use of condoms on their own may not be enough for HIV prevention among PLWHAs who desire children. Additional methods such as use of ART to reduce HIV infectiousness and sperm washing are needed.

Barriers to use of antiretroviral drugs in Rakai district of Uganda.

BACKGROUND: About 75% of people living with HIV/AIDS (PHAs) who need antiretroviral therapy have no access to these drugs in low-income countries. OBJECTIVE: To investigate the barriers to use of ART in Rakai district of Uganda. METHODS: We interviewed 38 key informants and 384 PHAs. Data was collected on: education/mobilization for ART, sources of information for ART, beliefs regarding ART, social support, use of alternative medicine, stigma/discrimination towards PHAs, distance to ART centres, transport costs to ART centres, waiting time, and on suggestions as how to improve the use of ART. RESULTS: The major barriers mentioned regarding use of ART included: inadequate mobilization, long waiting time at ART treatment centres, high cost of transport to reach ART centres, stigma/discrimination towards PHAs and inadequate number of health workers to attend to PHAs. CONCLUSIONS: Access to antiretroviral therapy could be ameliorated by: improving community education using innovative approaches such as through music, dance and videos, increasing the number of providers who are able to provide ART as through engagement of non health professionals in ART care, bringing ART nearer to where people live and instituting measures aimed at reducing stigma/discrimination such as through involvement of PHAs in demystisfying HIV/AIDS.

Barriers to use of Antiretroviral Drugs in Rakai District of Uganda

Background: About 75of people living with HIV/AIDS (PHAs) who need antiretroviral therapy have no access to these drugs in low-income countries. Objective: To investigate the barriers to use of ART in Rakai district of Uganda Methods: We interviewed 38 key informants and 384 PHAs. Data was collected on: education/mobilization for ART; sources of information for ART; beliefs regarding ART; social support; use of alternative medicine; stigma/discrimination towards PHAs; distance to ART centres; transport costs to ART centres; waiting time; and on suggestions as how to improve the use of ART. Results: The major barriers mentioned regarding use of ART included: inadequate mobilization; long waiting time at ART treatment centres; high cost of transport to reach ART centres; stigma/discrimination towards PHAs and inadequate number of health workers to attend to PHAs. Conclusions: Access to antiretroviral therapy could be ameliorated by: improving community education using innovative approaches such as through music; dance and videos; increasing the number of providers who are able to provide ART as through engagement of non health professionals in ART care; bringing ART nearer to where people live and instituting measures aimed at reducing stigma/discrimination such as through involvement of PHAs in demystisfying HIV/AIDS

Factors associated with delayed diagnosis of HIV infection in Mukono District, Uganda.

OBJECTIVE: To identify factors associated with delayed diagnosis of HIV infection. DESIGN: Cross sectional study. SETTING: Mukono district, Uganda. SUBJECTS: Newly diagnosed HIV positive clients at ten HIV testing centres. Late testers were HIV positive clients who had AIDS according to World Health Organisation AIDS case definition. Early-testers did not have AIDS at diagnosis. MAIN OUTCOME MEASURES: Late testers were compared to early testers on socio-demographic characteristics, sexual behaviour, access of testing services, knowledge of care and support services for HIV/AIDS and attitude towards knowing HIV-status. RESULTS: Delayed diagnosis of HIV infection was independently associated with being over 25 years (adjusted odds ratio (AOR), 4.3; Confidence Interval (CI) 1.7-11.1), not being married (AOR, 2.4; CI 1.3-4.4), having no knowledge of testing services (AOR, 2.4; CI, 1.2 4.7), spending at least one hour travelling to a testing centre (AOR, 2.1; CI, 1.0-4.2), paying for HIV testing (AOR, 3.4; CI, 1.7-6.9) having had an illness two months before testing AOR 9.49; CI, 4.84-18.64) and having negative beliefs towards knowing one's HIV sero status (AOR, 5.7; CI, 1.0-30.8). CONCLUSION: Factors associated with delayed diagnosis of HIV infection in Mukono District of Uganda are; age over 25 years, not being married, having no knowledge of testing services, paying for HIV testing, travelling for at least one hour to a testing centre and having negative beliefs towards knowing one's HIV status. In order to increase access to testing there is need to offer free HIV testing and health education targeting people above 25 years and those not married.

Adherence to feeding guidelines among HIV-infected and HIV uninfected mothers in a rural district in Uganda.

OBJECTIVE: To describe the infant feeding behaviour of HIV-infected and HIV-uninfected mothers, and identify factors influencing adherence to infant feeding guidelines. DESIGN: Analytical cross-sectional study. SETTING: Bushenyi, rural district in South-western Uganda PARTICIPANTS: One hundred and ninety four mothers who had a child less than 12 months of age. About half, 94 (48.5%), of these were HIV-infected. MAIN OUTCOME MEASURES: Proportion of mothers who exclusively breastfed, complementary fed, replacement fed, and adhered to feeding guidelines. RESULTS: Most (84.5%, 164/194) of the mothers had ever breastfed their infants, the rest had exclusively replacement fed since birth. Among children less than six months who were breastfeeding, 31.5% (34/108) were exclusively breastfeeding and the rest were mixed feeding. HIV-infected mothers were more likely than HIV-uninfected mothers to exclusively breastfeed (Crude Odds Ratio [COR], 3.61, 95% Confidence Interval [CI] 1.42-9.21). For infants older than six months, complementary feeding was more common among HIV-uninfected (100%) than HIV-infected mothers (41.7%; P < 0.001). Among infants of all ages, none of the HIV-uninfected and 45% of HIV-infected mothers were replacement feeding (p < 0.001). More than a half (59.8%) of the mothers adhered to infant feeding guidelines. The only independent predictor of adherence after multivariate analysis was mother ever attending infant feeding counselling (AOR 9.03; 95% CI 4.03-20.25). Only 35% of mothers reported ever attending infant feeding counselling. CONCLUSIONS: Infant feeding counselling was associated with improved adherence to feeding guidelines. Since infant feeding counselling is low in this population there is need for scale-up of this essential service.

Factors Influencing Disclosure of HIV Positive Status in Mityana District of Uganda

Background: Disclosure of HIV positive sero-status to sexual partners; friends or relatives is useful for prevention and care. Identifying factors associated with disclosure is a research priority as a high proportion of persons living with HIV/AIDS (PHA) never disclose. Objective: To identify factors associated with disclosure among PHAs in Mityana district of Uganda. Methods: Using a case control design; we compared 139 PHAs who had disclosed to 139 PHA who had not disclosed regarding socio demographic characteristics; sexual behaviour; individual experiences and perceptions about disclosure; as well as on health facility/community correlates of disclosure. Results: The independent factors that favour disclosure are not fearing negative outcomes of disclosure adjusted odds ratio (AOR) 7.00; 95confidence interval (95CI) 3.03-16.95; having communication skills to disclose (AOR 12.08; 95CI 4.94-29.51); having initiated anti-retroviral therapy (AOR 7.51; 95CI 3.42-16.49); not having tested for HIV during ante-natal clinic (AOR 5.07; 95CI 1.95-13.10); receiving ongoing counselling (AOR 4.33; 95CI 1.50-12.51) and having ever seen a PHA publicly disclose his/her HIV status AOR 2.73; 95CI 1.24-6.02). Conclusions: PHAs that have not initiated anti-retroviral therapy (ART); test for HIV in ante-natal clinic and fear negative outcomes need more help in disclosure. Measures that empower PHA to disclose such as those that lead to improved Counselingskills should be reinforced during ongoing counselling

Factors influencing adherence to exclusive breast feeding among HIV positive mothers in Kabarole district, Uganda.

OBJECTIVE: To identify the factors influencing adherence to exclusive breast feeding (EBF) among HIV positive mothers in Kabarole district, Uganda. DESIGN: Cross-sectional study. SETTING: Kabarore district, western Uganda. SUBJECTS: HIV infected women attending for psychosocial support that adhered or did not adhere to EBF. MAIN OUTCOME MEASURES: We compared personal factors, influence from other people, barriers and supports towards adherence to EBF among 139 HIV infected women who adhered and among 139 women who did not adhere to EBF using univariate and multivariate analyses. RESULTS: The independent predictors of adherence to EBF are: having formal education (Adjusted Odds Ratio [AOR] 2.21, 95% confidence interval [CI] 1.01-4.84), knowledge of EBF as a method of preventing mother to child transmission of HIV (AOR 2.53, CI 1.11-5.75), attending at least four antenatal infant feeding counselling sessions (AOR 3.86, CI 1.82-8.19), attending at least six postnatal counselling sessions (AOR 12.52, CI 3.89-40.30), health workers being consulted for breastfeeding problems (AOR 13.11, CI 3.75-45.81), mothers thinking that they are able to produce enough milk (AOR 3.92, CI 1.74-8.84), initiation of breastfeeding within one hour of birth (AOR 10.17, CI 4.52-22.88), getting support from the father to EBF (AOR 5.27, CI 1.87-14.81) and getting support from the family to EBF (AOR 4.54, CI 2.09-9.84). CONCLUSION: In order to improve adherence to EBF there is need to: involve the family especially fathers in infant feeding counselling and education, target less educated mothers for more intense infant feeding counselling using appropriate methods, intensify education on benefits of EBF and on how to produce enough milk and to encourage mothers to attend regularly for ante-natal and post-natal care.

Community perception of intestinal schistosomiasis in Busia district of Uganda.

OBJECTIVE: To elicit and understand peoples' perceptions of intestinal schistosomiasis that is a prerequisite for designing appropriate control strategies. DESIGN: Cross-sectional study using six focus group discussions (FGDs) and 432 semi-structured interviews (SSIs). SUBJECTS: Community members in Busia district of Uganda. MAIN OUTCOME MEASURES: Data was collected on causes, transmission, health seeking behaviour, hygiene behaviour and on prevention/control strategies for schistosomiasis. RESULTS: The symptoms of early intestinal schistosomiasis were poorly understood whereas those of late schistosomiasis were well appreciated. Cause and transmission of schistosomiasis were used interchangeably and schistosomiasis was mainly thought to be caused by drinking dirty or unboiled water. Schistosomiasis was perceived to be a treatable disease and modern medicines were said to be effective. Community members said that it is impossible to avoid contact with possible sources of infection for schistosomiasis as the lake was linked to livelihood of people. The groups that were particularly at increased risk of not participating in schistosomiasis prevention strategies included women, the uneducated and those involved in subsistence agriculture. CONCLUSIONS: In order to effectively control schistosomiasis in this district, there is need to adapt prevention and control strategies to peoples' livelihoods. There is also need to target the less advantaged groups (women, uneducated and subsistence farmers) for intense health education strategies aimed at increasing participation in the control of schistosomiasis.

"False Teeth ""Ebiino"" and Millet Disease ""Oburo"" in Bushenyi District of Uganda"

"Background:""False teeth"" (Ebiino) and ""Millet disease"" (Oburo; Tea-tea) have been reported in Uganda and other countries in Sub-Saharan Africa. These two perceived diseases are commonly reported in children under-five years of age. Anecdotal and published evidence suggests that these conditions are associated with moderate to severe childhood diseases such as malaria; pneumonia and diarrhoea and that most health seeking behaviour for the conditions is from traditional healers. Objectives:To estimate how common the 2 perceived diseases (false teeth and millet disease) are and describe health seeking behaviour for the two diseases. Methods: We did a cross-sectional survey using an interviewer administered questionnaire with closed and open questions in Bushenyi district; Uganda. The participants included 215 heads of households or their spouses obtained by cluster random sampling of 30 villages. Participants answered questions regarding occurrence of false teeth and millet disease disease in the household; treatment sought for false teeth and millet disease; perceived causes of false teeth and millet disease and about social economic situation of the household. Results: More than one in two of the households had a child less than five years who suffered from false teeth or millet disease in the last five years. More than 80of the respondents used traditional medicine alone or in combination with modern medicine to treat false teeth and or millet disease. Occurrence of false teeth and millet disease disease were favoured by low education status and not living in a house with cemented floor or having a brick wall. Use of traditional medicine was not associated with social economic conditions. Conclusions: The frequency of the perceived diseases false teeth and millet disease disease is high and may be attributed to low access to preventive and curative health services"

Contraceptive use among in and out-of school adolescents in rural southwest Uganda.

OBJECTIVE: To compare the level of contraceptive use among in and out-of school rural Ugandan adolescents. DESIGN: Cross sectional survey. SETTING: Mbarara district. SUBJECTS: Five hundred in-school and 220 out-of school adolescents aged 15-19 years. MAIN OUTCOME MEASURE: Contraceptive use. RESULTS: Contraceptive prevalence was 171 (23.8%), with 99 (19.8%) among in-school and 72 (32.7%) in out-of school (OR=0.8, 95% CI=0.5-1.3). Of the 286 who had had sexual intercourse, 171 (59.8%) were current users with 99 (57.9%) in-school and 72 (42.1%) out-of school. The predominant method was the male condom with 80 (56.7%) in-school and 61 (43.3%) out-of-school (p=0.3). Sixty five (67%) of in-school aged 18-19 used contraceptives compared to those less than 18 years (OR=0.4, 95% CI=0.2-0.8). The out-of school who were urban residents 51(75%) were more likely to use contraceptives (OR=0.3, 95% CI=0.1-0.6). Out-of school with secondary education 37(84.1%) were more likely to use contraceptives (OR=0.2, 95% CI=0.1-0.5). Cost was a barrier for contraceptive use among in-school users 37(77.1%) (OR=2.6, 95% CI=1.7-5.4). Stigma surrounding their sexual activity was a barrier to out-of school 25 (58.1%) (OR=0.4, 95% CI=0.2-0.8). CONCLUSION: Contraceptive use among rural sexually active adolescents is low although the prevalence is higher in out-of school. Reorientation of contraceptive services to make them more accessible through strengthening of school health programme and establishment of out-of school adolescent health programme are urgently needed.

Risk factors for recurrent sexually transmitted infections in Uganda

To identify predictors of recurrent sexually transmitted infections (STIs). Design: A cross-sectional interview survey. Setting: STD Clinic; Old Mulago; Kampala. Methods: Eligible patients answered questions about their socio-demographic situation; STI symptoms; sexual behaviour; sexual partner referral; health seeking behaviour and whether they had a recurrent infection or not. Bivariate and multivariate stepwise logistic regression models were used to identify independent predictors of recurrent STIs. Results: Fifty two (38) out of 138 patients had recurrent STIs. On bivariate analysis the predictors of recurrent STIs were: being male; age -25 years; inability to read in eng; presenting with genital itching; attributing source of symptoms to sexual partner; not being asked to refer sexual partners at previous treatment site; having more than five lifetime partners; knowing how to use a condom; ever using a condom; and using a condom at least once in the previous three months. On multivariate analysis; idnependent risk factors for recurrent infection were: age -25 years (Adjusted Odds Ratio [AOR] = 2.70; 95CI 1.20; 5.88); inability to read eng AOR = 3.09; (95CI 1.38; 6.92); and having more than five; lifetime partners AOR = 2.56 (95CI 1.11; 5.88). Conclusion: Reducing the number of sexual partners and targeting people who do not speak eng with health education messages in the local language may reduce the frequency of recurrent STIs

Predictors for compliance with community directed ivermectin treatment in Bushenyi district of Uganda: qualitative results.

OBJECTIVE: To understand and elicit the factors influencing compliance with mass treatment with ivermectin for onchocerciasis control with a view of suggesting remedial measures. DESIGN: Qualitative methods using focus group discussion and individual key informant interviews. SETTING: Bushenyi district, Uganda. PARTICIPANTS: Fifty key informants who were local council chairpersons and community directed drug distributors (CDDs) for ivermectin. Five focus group discussions with community members. MAIN OUTCOME MEASURES: Explored knowledge about onchocerciasis and its treatment, consequences, benefits and perceived dangers of treatment with ivermectin. In addition the FGDs elicited information regarding social influence towards ivermectin treatment and who the source of social influences are. Perceived barriers and supports towards ivermectin treatment were also explored. The key informant interviews mainly elicited the problems they face in ivermectin distribution and their suggestions for improvement. RESULTS: Factors that could possibly influence mass treatment with ivermectin that were elicited include consequences of treatment, programme organization, charging for ivermectin distribution and programme/community support to the ivermectin drug distributors. CONCLUSIONS: These results are helpful in redirecting community education and in helping to design further quantitative research.

Community chloroquine distribution for malaria control in Bushenyi district of Uganda.

OBJECTIVE: To document successful community chloroquine distribution for malaria control in Bushenyi district, southwestern Uganda. DESIGN: A cross sectional survey immediately after a four-month community chloroquine distribution exercise. One hundred sixty seven distributors in 140 out of 166 parishes in Bushenyi district did the chloroquine distribution during the 2001 malaria epidemic. PARTICIPANTS: A cluster random sample of 215 heads of households or their spouses were interviewed using a pre-tested questionnaire. MAIN OUTCOME MEASURES: Socio-demographic characteristics, malaria/fever morbidity, health seeking behaviour in the previous four months, knowledge about chloroquine distribution, opinions about the chloroquine distribution exercise and whether the household had used the service of the chloroquine distributors. RESULTS: Thirty per cent of the people surveyed had suffered from malaria in the previous four months. Seventy per cent of the households were aware of the chloroquine distribution and 56% of the patients who had malaria in the previous four months accessed the services of chloroquine distributors. People who were aware of chloroquine distributors were less likely to use services where a fee is levied. The total cost of chloroquine distribution was about 20,000 United States dollars. CONCLUSIONS: Community chloroquine distribution can increase access to treatment and can be done in a short time at an affordable cost.

Factors influencing acceptability of voluntary counselling and testing for HIV in Bushenyi district of Uganda.

OBJECTIVE: To understand the factors influencing choice of voluntary counselling and testing (VCT) for HIV with a view of suggesting measures for increased uptake. DESIGN: Focus group discussions were used to elicit reasons for carrying out VCT and a cross sectional survey to estimate the proportion of people who undertake VCT. SETTING: Bushenyi district, Uganda. PARTICIPANTS: A cluster random sample of 219 people and four purposively selected focus group discussions with 32 participants. MAIN OUTCOME MEASURES: Elicited attitudinal beliefs, self-efficacy expectations, and social influences that are probably associated with VCT for HIV based on the Attitude Social influence self-Efficacy (ASE) Model. The proportion of people who had ever undertaken VCT for HIV was also determined. RESULTS: Thirty-eight (17%) of the 219 people interviewed had ever undergone HIV. The factors influencing VCT for HIV were consequences of a test result, influences from a sexual partner, cost of VCT, physical accessibility of VCT, awareness, risk of HIV infection, need for linking VCT with care (especially availability of anti-retrovirals) and perceived quality of care of VCT services. CONCLUSIONS: Increased mobilisation and access for VCT, reducing costs of VCT, linking of VCT with care, and emphasising the positive consequences of VCT as well as providing high quality VCT services may increase the number of people seeking VCT.

Psycho-social determinants for sexual partner referral in Uganda: quantitative results.

The purpose of this study was to investigate the factors influencing sexual partner referral using the Attitude-Social influence self-Efficacy model as a guiding theoretical framework. The data was collected in an interview survey with 236 women and 190 men attending a sexually transmitted disease clinic in Kampala, Uganda. Intention, attitude, subjective norm, self-efficacy, and past behaviour in relation to partner referral as well as partner type were collected at time 1. At time 2 (1 month later), sexual partner referral was assessed. Intention, self-efficacy, and previous behaviour predicted partner referral for women whereas intention, partner type and previous behaviour predicted partner referral for men. For the women the strongest predictors for intention were self-efficacy followed by attitude and partner type. For the men the strongest predictor was attitude followed by partner type and self-efficacy. Social influence was a better predictor of intention for women than for men. An analysis of underlying cognitive beliefs discriminating those who referred and those who did not refer the sexual partner showed that attitudinal beliefs were the most important for men whereas self-efficacy beliefs were the most important for women. The targeting of the gender-based discriminatory beliefs in intervention may improve compliance with sexual partner referral.

Efficacy of patient-delivered partner medication in the treatment of sexual partners in Uganda.

BACKGROUND: Patient-based partner referral (PBPR), which is the main method for treating sexual partners of patients with sexually transmitted diseases (STDs), has limited effectiveness. GOAL: The authors compared the efficacy of PBPR with patient-delivered partner medication (PDPM) among patients attending the Mulago STD clinic in Kampala, Uganda. STUDY DESIGN: A total of 383 patients (187 women, 196 men) with STDs were randomized to the PBPR or PDPM group. The proportion of sexual partners treated in either group was compared using the chi-square statistic by intention to treat for partners whose follow-up status was unknown. RESULTS: The two groups had similar background characteristics. Of the 237 partners elicited, 176 (74%) were reported treated in the PDPM group. In the PBPR group, in which 234 partners were elicited, 79 (34%) were referred to the treatment clinic. This difference was statistically significant (risk ratio [RR], 2.44; 95% CI, 1.95-3.07; P < 0.001). Furthermore, PDPM was more effective than PBPR for women and for casual partners for whom PBPR is considered difficult. For women, 86 of 103 partners in the PDPM group were reported treated, compared with 23 of 104 partners in the PBPR group (RR, 4.55; 95% CI, 2.92-7.08; P < 0.001). For casual partners, 18 of 51 (34%) were reported treated in the PDPM group, compared with only three of 45 partners (7%) who were referred in the PBPR group (RR, 1.43; 95% CI, 1.40-2.65; P < 0.01). CONCLUSION: Patient-delivered partner medication is more effective than patient-based partner referral in the treatment of sexual partners.

The challenge of chloroquine-resistant malaria in sub-Saharan Africa.

For the last decade chloroquine-resistant Plasmodium falciparum (CRPF) has spread explosively in sub-Saharan Africa. In some areas of the continent, CRPF is so intense that chloroquine can hardly be said to have any efficacy. There is emerging evidence that CRPF is linked with increased incidence of mortality, severe disease and emergence of epidemics. Whereas the normal response to this trend of events would be replacing chloroquine with another effective drug, such a decision is hampered by the limited number of antimalarials currently available. There is a fear that changing too early would lead to depletion of available drugs. Yet a delay may be costly and catastrophic. Since the development of new antimalarials is deemed commercially unviable by high-income countries, there is need for a pan-African project aimed at the development of new antimalarials. Such a project could be jointly funded from African governments and the donor community under the coordination of either the World Health Organization or the Organization of African Unity. To delay the emergence and spread of resistance by P. falciparum to new and old drugs, there is need for: improving rational drugs use; limiting mass use of drugs as in chemoprophylaxis and in medicated salt; and increasing the use of impregnated bed nets.