Taenia solium metacestode preparation in rural areas of sub-Saharan Africa: a source for diagnosis and research on cysticercosis.

BACKGROUND: Taenia solium metacestodes/cysts obtained from pig carcasses constitute a primary source for diagnostic tools used for the detection of human cysticercosis. Data on T. solium cyst preparation in Africa is still scarce but required to establish independent reference laboratories. OBJECTIVES: The aim of the present study is a) to present the likely yield of T. solium cyst material by the use of two different preparation methods in the field and b) to investigate its suitability for immunodiagnosis of human cysticercosis. METHODS: In Zambia, Uganda and Tanzania 670 pigs were screened for T. solium infection. Cysts were prepared by 'shaking method' and 'washing method'. Generated crude antigens were applied in a standard western blot assay. RESULTS: 46 out of 670 pigs (6.9%) were found positive for T. solium (Zambia: 12/367, 3.3%; Uganda: 11/217, 5.1%; Tanzania 23/86, 26.7%). Mean values of 77.7 ml whole cysts, 61.8 ml scolices/membranes and 10.9 ml cyst fluid were obtained per pig. Suitability of collected material for the use as crude antigen and molecular diagnostic techniques was demonstrated. CONCLUSION: This study clearly shows that T. solium cyst preparation in African settings by simple field methods constitutes an effective way to obtain high quality material as source for diagnostic tools and research purposes.

OBSTACLES TO FAMILY PLANNING USE AMONG RURAL WOMEN IN ATIAK HEALTH CENTER IV, AMURU DISTRICT, NORTHERN UGANDA.

BACKGROUND: Uganda's rapid population growth (3.2%) since 1948 has placed more demands on health sector and lowered living standard of Ugandans resulting into 49% of people living in acute poverty especially in post conflict Northern Uganda. The population rise was due to low use of contraceptive methods (21% in rural areas and 43% in urban areas) and coupled with high unmet need for family planning (41%). This indicated poor access to reproductive health services. Effective use of family planning could reduce the rapid population growth. OBJECTIVE: To determine obstacles to family planning use among rural women in Northern Uganda. DESIGN: A descriptive cross-sectional analytical study. SETTING: Atiak Health Centre IV, Amuru District, rural Northern Uganda. SUBJECTS: Four hundred and twenty four females of reproductive ages were selected from both Inpatient and Outpatient Departments of Atiak Health Centre IV. RESULTS: There was high level of awareness 418 (98.6%), positive attitude 333 (78.6%) and fair level of utilisation 230 (54.2%) of family planning. However, significant obstacles to family planning usage included; long distance to Health facility, unavailability of preferred contraceptive methods, absenteeism of family planning providers, high cost of managing side effects, desire for big family size, children dying less than five years old, husbands forbidding women from using family planning and lack of community leaders' involvement in family planning programme. CONCLUSIONS: In spites of the high level of awareness, positive attitude, and free family planning services, there were obstacles that hindered family planning usage among these rural women. However, taking services close to people, reducing number of children dying before their fifth birthday, educating men about family planning, making sure family planning providers and methods are available, reducing cost of managing side effects and involving community leaders will improve utilisation of family planning and thus reduce the rapid population growth and poverty.

DETERMINANTS OF FIRST ANTENATAL CARE VISIT BY PREGNANT WOMEN AT COMMUNITY BASED EDUCATION, RESEARCH AND SERVICE SITES IN NORTHERN UGANDA.

BACKGROUND: Antenatal care (ANC) aims mainly at prevention, early detection and management of general medical and pregnancy associated disorders. Early booking is recommended for maximum utilisation. OBJECTIVE: To investigate the determinants of first ANC visit and trimesters at which pregnant mothers enrol for ANC at the COBERS sites of Northern Uganda. DESIGN: A descriptive cross-sectional study. SETTING: Five community based Education, Research and Service sites (COBERS) of Atiak, Madi Opei, Mungula, Namukora and Pajule health centre, fours (HC IV) in the five respective districts of Amuru, Lamwo, Adjumani, Kitgum and Pader, Northern Uganda, from April to July 2013. SUBJECTS: Four hundred and seventeen (417) pregnant women attending antenatal care (ANC) in five health centres and ten purposively selected midwives were interviewed using questionnaires. RESULTS: Of the 417 respondents, only 11.5% (n = 48) had their first ANC at the recommended period of 0-16 weeks. Prevalence of late entry to ANC was 88.5% (n = 369). Mean gestational age at booking was 22.6 ± 5.7 weeks. Paternal level of education, outcome of previous pregnancy, previous ANC attendance, weeks of amenorrhea, convenience of opening hours at ANC facility, commuting distance from home to health facility, knowing the right time for ANC enrollment and pregnancy planning remained significant predictors governing early booking. CONCLUSION: Late ANC booking is still a major public health concern that demands public enlightenment and paternal education coupled with women empowerment will reduce the magnitude of the problem.

REASSESSMENT OF HELMINTH INFECTIONS IN GULU MUNICIPALITY NOTHERN UGANDA AFTER THE TWENTY YEARS OF INSURGENCY: USING THREE DIAGONOSTIC METHODS TO COMPARE THEIR SENSITIVITY.

BACKGROUND: During the period of insurgency there were several internally displace people camps all over the Northern Uganda. People who lived within ten kilometers from Gulu Municipality were forced to evacuate their villages and re-locate and build huts for themselves in areas identified for them by the government. There were several of such camps within the municipality creating influx of people from the villages to the municipality for security. Now with the situation restored to normal, there is need to re-assess and update information on the prevalence of helminth infections in Gulu municipality where many of the internally displaced people (IDP) settled. OBJECTIVE: To find out if S. mansoni and soil transmitted nematode infections are so prevalent and very common in children aged betweenfive to 20 years. In Gulu municipality and that additional preventive and curative measure need to be considered. Further is there a strong need to reconsider more sensitive diagnostic methods at the hospitals or does the standard approach of direct smear examination recognise at least most heavy infected children with any of the parasites. Setting. The study was carried out in Gulu municipality. DESIGN: Purposive and random sampling methods were used. Study Population: Mainly Primary school children aged between five to 20 years randomly selected from four primary schools purposively selected around Gulu municipality were recruited for the study. For control 20 staff of each school randomly selected were also studied. RESULTS: Of the 582 samples tested, 117(20.1%) were found positive for Schistosoma mansoni. Fifteen (2.6%) other samples were found positive for other helminths like Ascaris lumbricoides, Trichuris trichiura H.nana Hookworm. The comparison between the methods showed that the results obtained by the three methods were similar for field research. There is a low intensity of infection with soil transmitted helminths found in the primary schools around Gulu municipality. CONCLUSION: We concluded that the prevalence and intensity of infection with soil transmitted helminths was low among the children aged between 5 to 20 years in the four primary school studied (2.6%) but there was medium infection with S.mansoi (20.1%). The sensitivity in detecting the helminthes eggs in the stool specimen were similar. Though the original Kato/Katz method recorded lowest egg count than the Polderman and Odongo-Aginya methods. This could be due to the fact that the slides were read immediately.

RISK FACTORS FOR ROAD TRAFFIC ACCIDENTS IN GULU MUNICIPALITY, UGANDA.

BACKGROUND: Currently Road Traffic Accidents (RTA) are ranked tenth among the leading causes of death and ninth among all leading causes of disability worldwide. There has been no published study on RTA in Gulu municipality. There is a high frequency of RTA in Gulu municipality with poor road design and inadequate knowledge on road safety precaution among road users. OBJECTIVES: To establish the causes of Road Traffic Accidents (RTA), establish the safety measures in place to protect road users to avoid RTA and establish people mostly involved and the mechanism of RTA. DESIGN: A cross-sectional study. SETTINGS: Four divisions of Gulu Municipality; Layibi, Laroo, Pece and Bardege. SUBJECTS: Two hundred and forty two participants including pedestrians, drivers of different categories of vehicles, motorcyclists and bicyclists locally known as boda-boda and the police were interviewed. RESULTS: Most respondents reported RTA as a problem in Gulu municipality (96%), causing death (48%), financial constraint due to medical treatment (41%) and disability (11%). The following causes of RTA were identified; reckless driving and riding (49%), poor road design (24%), drug abuse (15%) and over loading (12%). According to police records of January to September 2009 RTA involved pedestrians (36.34%), passengers (25.80%), motorcyclists (24.88%), pedal cyclists (11.52%) and drivers (3.68%). CONCLUSION: RTAs is a substantial burden in Gulu municipality in Northern Uganda with reckless driving or riding, poor road design, overloading, double parking, inadequate road safety signs and knowledge, were major risk factors. Efforts to reduce RTA in Gulu municipality should aim at addressing these problems.

SCHISTOSOMA MANSONI INFECTION AND THE ASSOCIATED ANTIBODY IMMUNE RESPONSE AMONGST RESIDENTS OF KIGUNGU ENTEBBE, UGANDA.

UNLABELLED: BACNKGROUND: There are many foci endemic for Schistosoma (S.) mansoni in Uganda. The immune responses to infection with the parasites in these areas have been found to vary with host sex, age and infection intensity. OBJECTIVE: To determine the profile of antibody isotypes responses against S. mansoni crude soluble egg antigens (SEA) and soluble adult worm protein (SWAP) antigens that determine the host resistance or susceptibility to reinfection. DESIGN: Cross Sectional, cohort study. SETTING: Kigugu fishing village in Entebbe, Uganda. SUBJECTS: Nine hundred and forty five (945) Kigungu residents reported forpre-treatment screening and enrolment and 626 cohorts report for post-treatment screening and enrolment 18 months later. RESULTS: Pearson's Chi-sq2 showed thatincrease in titres of anti (SWAP IgE, SEA IgE, and SEA IgG2) was not significant, but increase in anti SEA IgG3 was significant. Decrease in titres of anti (SWAP IgG1, SEA IgG1, and SEA IgG4) was not significant but decrease of anti (SWAP IgG2, SWAP IgG3 and SWAP IgG4) was significant. Positive correlation existed between age and anti SWAP IgE in before and after treatment sera. On the contrary, age was positively correlated with anti SWAP IgG4 in pre-treatment sera but was negatively correlated with anti SWAP IgG4 in the post-treatment sera. In addition there were positive correlation between higher egg counts and the immunoglobulin levels of anti SWAP IgG4 and anti SEA IgG4 but negative correlations were observed between anti SWAP IgE and anti SEA IgE. Conversely low egg counts were associated with high levels of anti SWAP IgE. Furthermore, IgG1-4, IgE antibody to SEA and SWAP antigens did not differ significantly according to sex. CONCLUSION: We concluded that praziquantel treatment of S. mansoni infected persons alter the immune responses that are influenced by age and intensity. A phenomenon that is useful in the effort to produce vaccine against schistosome.

Evidence of Long Term Benefit of Praziquantel Treatment Against Schistosoma mansoni in Kigungu Fishing Village of Entebbe, Uganda

Praziquantel (PZQ) is efficacious against all species of schistosome: Schistosoma mansoni; Schistosoma haematobium; Schistosoma japonicum and other parasites like the Taenia species. This cross-sectional cohorts study was carried out in Kigungu fishing village along Lake Victoria shore in Entebbe Uganda. Our analysis was based on examining microscopically three slides from a single stool specimen from each of base line cohorts 945.These included children and adults; participants from both sexes in Kigungu fishing village in Entebbe Uganda. Nine hundred and one (901) of the cohorts were re-examined after six months and 625 of the same cohorts who were examined at the baseline and after six months were re-examined 18 months later. The slides were prepared using modified Kato/Katz (Odongo-Aginya) method. The infection proportion with Schistosoma mansoni at baseline was 448 (47.5) but this was reduced to 244 (25.8) 18 months after treatment with a single oral dose of praziquantel at 40mg/kg. However 495 (52.5) were negative at the baseline study. The cure proportion after six was significant ///{(P=0.00); (OR4.63) CI at 95(3.53-6.06)///}. Similarly the cure proportion after 18 months was significant ///{(P=0.00); (OR2.2) CI at 95(1.87-3.34)///}. The force of re-infection after six months was significant ///{(P=0.0001); (OR 0.47) CI at 95(0.31-0.71)///}. Nevertheless the force of re-infection was not significant after 18 months ///{(P=0.766); (OR 0.95) CI at 95(0.68-1.34)///} eggs excretion did not reach the level of the pre-treatment intensity. The egg reduction was 69.3. This was associated with age and pre-treatment intensity 400 eggs per gram (epg) of faeces and age groups ? 30 years. The egg reduction also resulted in marked decrease in clinical symptoms in the participants. Our study suggests evidence of long-term benefit of praziquantel in Kigungu and that the re-infection occurred more commonly in younger age group than in the older patients

Antibiotic susceptibility of Staphylococcus aureus in suppurative lesions in Lacor Hospital, Uganda.

BACKGROUND: Staphylococcus aureus, a mainly acquired hospital infection is responsible for many suppurative lesions and has demonstrated the ability of developing resistance to many antimicrobial agents leading to life threatening infections and long hospital stay. OBJECTIVE: To determined the prevalence and antibiotic susceptibility of Staphylococcus aureus in suppurative lesions of the surgical ward and outpatients of Lacor Hospital (Uganda). METHODS: A cross-sectional study was conducted at St. Mary's Hospital Lacor to determine the prevalence and antibiotic susceptibility profiles of Staphylococcus aureus in suppurative lesions in both surgical inpatients and outpatients. Using culture techniques on MacConkey and blood agar, Staphylococcus aureus was isolated based on the colonial characteristics and confirmed by Catalase and tube Coagulase tests. The antibiotic susceptibility test was done using Kirby-Buer disk diffusion method on 4% Salt Muellar Hinton II agar for the Methicillin and non salted Muellar Hinton II agar for the other antibiotics (NCCLS M100S9). RESULTS: The prevalence of Staphylococcus aureus in 122 patients sampled was 59.4% for the surgical inpatients and 48.3% for outpatients giving an average prevalence of 53.9% for both groups of patients. The average antibiotic susceptibility patterns for the 8 antibiotic tested were: Ampicillin (75.0%), Chloramphenicol (34.4%), Ciprofloxacin (1.6%), Erythromycin (7.8%), Gentamycin (0%), Methicillin (1.6%), Tetracycline (45.3%) and Co-trimoxazole (50.0%). The resistance in surgical inpatients was significantly higher than outpatients (t=1299, p<0.05) and Methicillin resistance was confirmed by PCR. CONCLUSION: Staphylococcus aureus is highly prevalent and more resistant in inpatients. There is a higher risk of acquiring drug resistant staphylococcus aureus infection in inpatients of Lacor Hospital with a Methicillin resistance of 0% and 2.6% for out and inpatients respectively.

Evidence of long term benefit of morbidity reduction due to praziquantel treatment against schistosoma mansoni in Kigungu fishing village in Entebbe, Uganda

Praziquantel (PZQ) is efficacious against Schistosoma mansoni. This was prospective cohort study. This study was carried out at Kigungu fishing village, Entebbe, Uganda. The goal of the study was to establish cost effective regiment for mass drug administration (MDA) of Praziquentel in the morbidity reduction of S.mansoni infection. In January 2004, nine hundred and forty five (945) participants were registered in this study. Our analysis was based on examining microscopically three slides prepared from each of 945 stool specimens delivered by each of the participant using modified Kato/Katz method. These included male and female, children and adults living in Kigungu fishing village in Entebbe Uganda. In total 901, cohorts were re-examined for infections clearance six months later in July 2004 and 18 months later in June 2005, 625 cohorts were again re-evaluated for S.mansoni infections after the baseline study. At baseline, (448) of 945 (47.5%) cohorts were S. mansoni positive. All these participants were treatment with a single oral dose of praziquantel at 40mg/kg. At the same time, 495 (52.5%) were S. mansoni negative. Of the 625 (66.3%) cohorts who came back for final review, 80 (12.8%) were still positive for S. mansoni while 210 (33.6%) remained negative after the base line treatment with praziquantel. On the other hand 103 (16.3%) of cohorts who were initially negative at the base line became S.mansoni positive after 18 months and 213(34.1%) remained negative for S.mansoni. The force of re-infection after six months was significant {(P=0.0001),(OR 0.47) CI at 95% (0.31-0.71)}. Nevertheless the force of reinfection was not significant after 18 months {(P=0.766), (OR 0.95) CI at 95% (0.68-1.34)}.The geometric mean eggs excretion of the 80 cohorts who were S.mansoni positive at 18 months was 151.967.This did not reach the geometric mean egg excreted by the same cohorts at baseline which was 285.05. The egg excretion was reduced by 46.8%. Similarly there was marked decrease in clinical symptoms amongst the cohorts. Our study suggests evidence of long-term benefit of praziquantel in Kigungu and that a yearly administration of praziquantel to the community could be a regiment for mass drug administration (MAD) for this community to control schistosomiasis morbidity

Bilharzia induced pathologies and techniques of detection in Uganda: a review.

BACKGROUND: Schistosoma S. mansoni was observed and reported in Uganda in 1902. Schistosoma S. mansoni is widely distributed in Uganda along permanent water bodies. OBJECTIVE: To review the literature on previous techniques and conventional ones used for the assessment and comparison of morbidity due to schistosomiasis in Uganda. DESIGN: Retrospective study. SETTING: Gulu University, Faculty of Medicine, Department of Microbiology and Immunology. RESULTS: Since its first detection in 1902 Schistosomiasis mansoni and later Schistosomiasis haematobium in Uganda, morbidity assessment was based on physical examination and intensity of eggs excretion. The first field study in Uganda of schistosomiasis pathologies using ultrasound was that conducted in West Nile in Obongi, Rhino Camp and Pundu in 1991 and reviewed in 1992. These armless and none invasive method of pathologies detection has the advantage of repeatability. It showed that after treatment there was reversibility of pathological conditions introduced by the parasites in the hosts. CONCLUSION: Schistosomiasis mansoni pathologies as detected by the none invasive ultrasound findings compared well with those of the more risky invasive liver biopsy. The detection of pathologies by clinical examination was less sensitive. Pathological lesions due to S. haematobium correlated with abnormalities of the urinary tract and intensity of eggs in urine.

Evaluation of schistosoma mansoni morbidity one year after praziquantel treatment in rhino cAMP and obongi in west nile, Uganda.

An evaluation study on reversibility of Schistosoma mansoni induced periportal fibrosis (PF) morbidity following treatment with praziquantel, 40mg/kg body weight after one year, was carried out in Rhino Camp and Obongi all are West Nile districts in northern Uganda. To assess the reversibility of Schistosoma (S) mansoni induced PFs morbidity following treatment with praziquantel, 40mg/kg body weight after one year. The design was a Prospective cohorts study; and the setting was a busy canoe landing sites along Albert Nile in Schistosoma (S) mansoni hyperendemic areas of Rhino Camp and Obongi fishing village were selected for the study. Previously in 2005, 1562 people including fishermen and women, school pupils, teachers, and civil servants were studied in both fishing villages for S. mansoni using Kato/Katz stool smear method. Abdominal ultrasonography and sonomorphological abnormalities of periportal fibrosis were performed with Aloka portable ultrasound machine (Hellige, Freiburg, Germany) fitted with a convex probe of 3.5 mega Hertz was also performed in the field clinic on all patients who had S. mansoni eggs in their faeces. The sonomorphological abnormalities of periportal fibrosis were categorised and organomorphometry of liver and spleen was done. One thousand two hundred and seventy three 1273 (81.5%) patients in Rhino Camp and Obongi fishing villages were found to be excreting from 100 to ≥ 500 eggs per gram (epg) of faeces of S. mansoni eggs. Two hundred and eighty nine (18.5%) did not have eggs of S.mansoni in their faeces. All the 1273 patients secreting eggs of S.mansoni in their stool in Rhino Camp and Obongi fishing villages had abdominal ultrasonography and sonomorphological abnormalities of periportal fibrosis. Eight hundred and forty 840 (66%) although excreted S. mansoni eggs in their stool had Pf (0); Pf grade (I), n=259 (20.3%); Pf grade (II) n =147 (11.5%); and Pf grade (III) n=27 (2.1%) were observed.

Effect of seasonal rainfall and other environmental changes, on snail density and infection rates with Schistosoma mansoni fifteen years after the last snails' study in Kigungu, Entebbe, Uganda.

BACKGROUND: The last study on snail population density in relation to rainfall pattern in Kigungu canoe landing and recreational sites on Lake Victoria shore was earlier carried out about fifteen years ago. This study also reviewed the influence of other environmental factors on the snails' infection rate. OBJECTIVE: To reassess the density dynamic of Biomphalaria (B) choanomphala and Biomphalaria (B) pfeifferi, which act as the intermediate host for S. mansoni and Bulinus (B) globosus, and Bulinus (B) tropicus, which act as intermediate host for S. haematobium. DESIGN: Retrospective study. SETTING: Busy canoe landing sites along Lake Victoria in Kigungu fishing village were selected for the snail sampling. RESULTS: Nine thousand one hundred and ninety four B. choanomphala were collected over the study period. The numbers of B. choanomphala collected in each yearwas 4742 (51.6%) and 4452 (48.4%) in 2004 and 2005 respectively. Of the 4742 B. Choanomphala collected in 2004, 82 (1.7%) shed human cercariae and 329 (6.7%) shed non-human cercariae. Whereas in 2005, out of 4452 B. choanomphala collected 302 (6.85%) shed non-human cercariae and 82 (1.8%) shed human cercariae. Similarly, 4173 B. pfeifferi were also collected in the same period. Out of which 2224 (53.3%) were collected in 2004 and 1949 (46.7%) in 2005. For B. pfeifferi, 42 (1.9%) out of 2224 snails collected in 2004 shed human cercariae and 246 (11.1%) shed non-human cercariae. While in 2005, 33 out of 1949 snails (1.7%) shed human cercariae and 159 (8.2%) shed non-human cercariae. Other snails of medical importance collected included 292 B. globosus and 3094 B. tropicus. None of the Bulinus spp. collected shed any human cercariae but 37 (2.1%) and 30 (2.3%) B. tropicus shed non-human cercariae in 2004 and 2005 respectively. In 2004 and 2005, the area received, 1729mm and 1959mm of rainfall respectively, The mean rainfall during the year was 144.05 mm and 163.3 mm in 2004 and 2005 respectively. There was a negative correlation between rainfalls and snail density dynamic. CONCLUSION: We have found in this study that in spite of the bush clearing of the papyrus swamps which originally was the major habitats for B. choanomphala, B. pfeifferi and the Bulinus spp the intermediate host for schistosome at all canoe landing sites at Kigungu, these snails are still present. Moreover, that their population density dynamic and infection rate are inversely proportional to the rainfall pattern.

Epidemiology; of Bilharzias (schistosomiasis) in Uganda from 1902 until 2005

Background: Schistosoma mansoni was observed and reported in Kuluva hospital Arua District in north western Uganda as early as 1902. S. mansoni is widely distributed in Uganda along permanent water bodies. Objective: To review the litreture on scistosomiasis in Uganda; since 1902. Method: The core literature for this short review was searched from reports and publications by the British colonial Ministry of Health Districts Medical officers and Entomologists. Additional information was obtained from Makerere University Medical School library archives; London School of Hygiene and Tropical Medicine library archives; University of Antrwap; and post independence publications on schistosomiasis in Uganda in various journals. Results: Since it was first detected in 1902 Schistosoma (S) mansoni is more widely distributed in Uganda than S. haematobium. However Schistosoma mansoni and S. haematobium are of public health importance in Uganda and the importance of migrants and fishermen in disseminating infections into non-infested areas and intensifying infection in areas already infested have been reported. Conclusion: S. mansoni has been on the increase in Uganda whereas S. haematobium is localized in sporadic foci in the north of Uganda. Treatment with praziquantel the drug of choice in Uganda used in schistosomiasis control programme has reduced development of severe schistosomiasis

Substitution of Malachite Green with Nigrosin - Eosin Yellow Stain in the Kato-Katz Method: Microscopical Appearance of the Helminth Eggs

Background:The Kato-Katz thick smear technique is the standard technique recommended by the World Health Organisation for the quantitative diagnosis of Schistosoma mansoni and other intestinal helminth infections.The major problem of the technique is that a few hours after the preparation of slides hookworm eggs over clear and disappear due glycerin. Objective:To illustrate clear visibility of different helminth eggs microscopically in Odongo-Aginya method; substitution of malachite green with 7.5nigrosin in 10formalin and 5eosin in 10formalin. Method: Measured; strained stool specimen was stained with mixture of nigrosin/ eosin and covered with cellophane cover slips.The prepared slide was examined immediately microscopically. Result: Slides prepared with Odongo-Aginya method can be examined immediately or later without compromising the visibility of parasite eggs and larvae. Hookworm eggs remain visible for a long time. Conclusion:The present publication shows microscopic appearance of the helminth eggs using the Odongo-Aginya modification

Relationship between malaria infection intensity and rainfall pattern in Entebbe peninsula, Uganda.

BACKGROUND: This study was to assess malaria prevalence in relation to rainfall pattern in different localities of Entebbe Municipality, Uganda. A cross sectional study was conducted amongst the local community residing in the area from January 2003 to January 2004 to investigate the incidence and intensity of malaria infection. METHODS: Thick and thin blood smears were made from each patient with fever (body temperature >or= 37.5 degrees C). The slides were examined microscopically for malaria parasites. A total of 616 residents aged 2 to 50 years were registered in the study by name, age, sex and residential location. Spearman correlation coefficient (r) was used to evaluate relationship between parasite density, age and body temperature on one hand and rainfall plus parasite density on the other hand. RESULTS: A direct relationship was observed between malaria transmission and monthly rainfall in Entebbe Municipality. About 69.8% of the patients had fever. Parasite density fluctuated according to monthly rainfall pattern. Two peaks of high parasite density was observed, each peak coinciding with a peak rainfall pattern of the bimodal annual rain seasons. There was a negative but significant correlation (r = -0.09271; p < 0.0214) between parasite density and age, suggesting that mature individuals clear parasites more effectively than children. Furthermore, we observed a bimodal peak of mean parasite density in children and adults; peak in children is higher than of adults, each peak coinciding with rainfall pattern. There is also a significant positive correlation between parasite density and body temperature (r = 0.1927; p = 0.0001). However, there is no significant variation in mean parasite densities in the different locations of Entebbe Municipality. CONCLUSION: Our study confirms rainfall pattern and age influence parasite density and are important determinants of malaria infection and transmission in Entebbe Municipality. Increased parasite density in children is a useful indicator for monitoring intensity of infection. This information is valuable in policy formulation for control of malaria during periods of intense transmission.

Evidence for a long-term effect of a single dose of praziquantel on Schistosoma mansoni-induced hepatosplenic lesions in northern Uganda.

Treatment with praziquantel reduces the prevalence and intensity of Schistosoma mansoni infection. However, reversibility of periportal fibrosis of the liver, which potentially leads to fatal complications, is not unequivocally substantiated. In the Nile District of Uganda, 460 patients were parasitologically (Kato-Katz method) and ultrasonographically examined during October 1991, October 1992, and May 1994. Treatment with praziquantel at a dosage of 40 mg per kilogram of body weight was given in October 1991 and October 1992 to 460 individuals (group A). Another 192 patients were seen during the baseline study in October 1991 and missed the follow-up in October 1992 but took part in the second follow-up in May 1994. Thus, they received praziquantel only once in October 1991 (group B) and had an interval of 2.7 years until the next investigation in May 1994. Periportal thickening (PT) of the liver was assessed by ultrasound at each time point. Praziquantel therapy reduced the prevalence of S. mansoni in group A from 84% in 1991 to 31% in 1992 and 30% in 1994. The respective intensities of infection (geometric means of egg output) were 81 eggs per gram (epg) of stool in 1991, 31 epg in 1992, and 30 epg in 1994. Periportal thickening was found in 46% of patients in 1991, 32% of patients in 1992, and 35% of patients in 1994. Reversibility of PT was influenced by age (markedly lower reversibility in individuals older than 30 years) and sex (women and girls responded less favorably than did men and boys). Surprisingly, no significant difference was detected between group A and group B with respect to reversibility of PT The outcome between the 2 groups did not differ significantly. This may indicate that a single dose of praziquantel (as given to group B) may have a longer lasting effect than previously thought, that is, more than 2.5 years.

Integrated control trial of schistosomiasis at Nakiwogo fishing village near Entebbe, Uganda.

Using the Kato Katz technique, 600 people living in Nakiwogo fishing village at Lake Victoria, Uganda, were examined for Schistosoma mansoni infection. The total population of this village was estimated between 1,000 and 1,500 mainly consisting of migrants from western Uganda. Of the 600 individuals in the study group, 328 people (54.7%) were found to be infected with S. mansoni. The geometric mean egg count was 422 eggs per gramme of stool. A survey of the snail intermediate hosts for S. mansoni and S. haematobium at Nakiwogo was carried out. The collected snails were tested for cercariae shedding. A significant decrease in the number of Biomphalaria choanomphala and Biomphalaria pfeifferi (52%) which both still shed cercariae and Bulinus tropicus (52.5%) could be observed. There was a lower none-significant decrease of 13.3% of the Bulinus globosus population. With a combined approach including community participation in control measures in the form of health education, sanitation, environmental management and chemotherapy, the prevalence of S. mansoni infection was reduced from 54.7% to 14.6% in the period of one year.

Schistosoma mansoni along Lake Albert, Kibale District, Western Uganda.

Four hundred and fifty one human strata living in the three fishing villages of Ndiaga, Kabukanga and Rwabikongoro along Lake Albert shore in Kibale District were examined for S. mansoni infection using Kato/Katz method. Of the 451 people, 409 (90.7%) were found infected with S. mansoni with geometric mean egg count of 561.3 eggs per gram (epg) faeces. Males had significantly higher mean egg counts than females, 608.3 epg and 415.6 epg respectively. All S. mansoni infected individuals were treated with praziquantel at 40 mg/kg body weight. Other common parasites observed were Asaris lumbricoides, Trichuris trichiura and hookworms. These were treated with mebendazole. Snail infection rate among the 115 Biomphalaria sudanica and the 56 B. stanleyi were 5.2% and 3.6% respectively. All the 66 Bulinus (B) tropicus found, were negative for cercariae shedding. The main pulmonate snails were 250 Lymnae natalensis, 500 Pila ovata and 375 Bellamya spp were the commonest prosobranchs followed by Bivalves (101).

Intergrated control trial of schistosomiasis at Nakiwogo fishing village near Entebbe; Uganda

Using the Kato katzi technique; 600 people living in Nakiwogo fishing village at Lake Victoria; Uganda; were examined for schistosoma mansoni infection. The total population of this village was estimated between 1;00 and 1;500 mainly consisting of migrants from Western Uganda. Of the 600 individuals in the study group; 328 people (54.7) were found to be infected with S. mansoni. The geometric mean egg count was 422 eggs per gramme of stool. a survey of the snail intermediate hosts for S. mansoni and S. haematobium at Nakiwogo was carried out. The collected snails were tested for cercariae shedding. A significant decrease in the number of Biomphalaria choanomphala and Biomphalaria pfeifferi (52) which both still shed cercariae and Bulinus (52.5) could be observed. There was a lower none-significant decrease of 13.3of the Bulinus globosus population. With a combined approach including community participation in control measures in the form of health education; sanitation; environmental management and chemotherapy; the prevalence of S. mansoni infection was reduced from 54.7to 14.6 in the period of one year

Schistosoma mansoni along Lake Alibert; Kibale district; Western Uganda

Four hundred and fifty one human strata living in the three fishing villages of Ndiaga; kabukanga and Rwabikongoro along Lake Albert shore in Kibale District were examined for S. mansoni infection using Kata/Katz method. Of the 451 people; 409(90.7) were found infected with S. mansoni with geometric mean egg count of 561.3 eggs per gram (epg) faeces. Males had significantly higher mean egg counts than females; 608.e epg and 415.6 epg respectively. All S. mansoni infected individuals were treated with praziquantel at 40mg/kg body weight. Other common parasites observed were Ascaris lumbricoides; Trichuris trichiura and hookworms. These were treated with mebandazole. Snail infection rate among the 115 Biomphalaria sudanica and the 56 B. stanleyi were 5.2and 3.6respectively. All the 66 Bulinus (B) tropicus found; were negative for cercariae shedding. The main pulmonate snails were 250 Lymnae natalensis; 500 Pila ovata and 375 Bellamya spp were the commonest prosobranchs followed by Bivalves (101)