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1.
J Eukaryot Microbiol ; 72(1): e13083, 2025.
Artigo em Inglês | MEDLINE | ID: mdl-39835397

RESUMO

All insect trypanosomatids of the subfamily Strigomonadinae harbor a proteobacterial symbiont in their cytoplasm and unique ultrastructural cell organization. Here, we report an unexpected finding within the Strigomonadinae subfamily: the identification of a new species lacking bacterial symbiont, represented by two isolates obtained from Calliphoridae flies in Brazil and Uganda. This species is hereby designated as Kentomonas inusitatus n. sp. Molecular investigations targeting symbiont DNA, cell proliferation, and ultrastructural analyses agreed with the absence of bacterial symbionts in cultured flagellates. PCR-screening specifically targeting symbiont DNA corroborated the absence of symbionts in K. inusitatus present in the intestine of the respective host flies. K. inusitatus exhibited forms varying in size and shape. While displaying overall ultrastructural features of the Strigomonadinae, the novel species showed mitochondrial branches juxtaposed to the plasma membrane in locations both without and notable, with subpellicular microtubules. The discovery of the first Strigomonadinae species naturally lacking a symbiont and closely related to K. sorsogonicus, suggests a unique evolutionary history for the genus Kentomonas. Our findings provide novel insights into the complex relationships between trypanosomatids and their symbionts.


Assuntos
Filogenia , Simbiose , Trypanosomatina , Animais , Trypanosomatina/classificação , Trypanosomatina/genética , Trypanosomatina/isolamento & purificação , Trypanosomatina/ultraestrutura , Brasil , Uganda , DNA de Protozoário/genética , DNA Bacteriano/genética
2.
BMC Oral Health ; 24(1): 1355, 2024 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-39511546

RESUMO

BACKGROUND: One of the most prevalent oral health issues affecting mankind is tooth loss. Besides extractions due to periodontal disease and caries, accidents and lack of dental knowledge can also result in tooth loss. Nevertheless, no known published studies have examined how edentulous patients in Uganda have lived with tooth loss. The objective of the present study was to investigate experiences of tooth loss among Ugandan edentulous patients attending Makerere University Dental Hospital. METHODS: This was a cross-sectional qualitative study using purposive recruitment of respondents. A total of 15 respondents were chosen from a variety of socio-economic groups. Qualitative data were collected using oral interviews in form of note taking and an audio-recorder. The data collected comprised the causes of tooth loss, the physical and psychological effects of losing teeth, the difficulties in managing oral hygiene when one is toothless, coping mechanisms, and supportive interventions after losing natural teeth. The collected data were transcribed and analyzed thematically using a software, Atlas Ti. The generated qualitative data were summarized as text, while demographic characteristics were presented in a table. RESULTS: Oral infections such as periodontal disease (which destroy tooth supporting tissues), tooth decay and trauma from accidents were reportedly the main causes of tooth loss. In case of tooth pain as a first symptom, most patients choose self-medication with over-the-counter drugs and home remedies. They only consult dental professionals when the condition deteriorates. Tooth loss was associated with problems of eating, facial aesthetics and low self-esteem. CONCLUSION: The present study found that tooth loss was caused by periodontal disease, tooth decay and trauma from accidents. Loss of teeth was escalated by poor health seeking behavior. Tooth loss resulted in pain, eating difficulties, speech difficulties, poor facial appearance and consequently low self-esteem.


Assuntos
Adaptação Psicológica , Boca Edêntula , Perda de Dente , Humanos , Uganda , Perda de Dente/psicologia , Feminino , Masculino , Estudos Transversais , Pessoa de Meia-Idade , Boca Edêntula/psicologia , Pesquisa Qualitativa , Adulto , Idoso , Higiene Bucal , Cárie Dentária/psicologia , Doenças Periodontais/psicologia , Doenças Periodontais/complicações , Traumatismos Dentários/psicologia
3.
J Glob Health ; 14: 04232, 2024 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-39575726

RESUMO

Background: Considering the well-established link between experiencing violence in childhood and poor mental health, it is important to understand the role of contextual factors in which young people live, learn, work, and play. Evidence has highlighted the importance of work as a contextual factor in the lives of young people, but it is unclear whether being in work mitigates, entrenches, or exacerbates the association between violence against children and poor mental health. Methods: This study is based on nationally representative data of males and females aged 13-24 years who completed the Violence Against Children Surveys in Nigeria, Uganda, and Colombia. We used multivariable logistic regression models to explore the association between lifetime violence and past 30-day mental distress, and explored whether working in the past year modified this association. All analyses were age- and sex-stratified and conducted separately in each country. Results: We found a high prevalence of lifetime violence among young people in all three countries and strong associations between violence and mental distress. In Colombia, there was strong evidence (P-value for interaction = 0.014) that work in the past year (adjusted odds ratio (aOR) = 0.42; 95% confidence interval (CI) = 0.07-2.57) reduced the risk of mental distress among girls who had experienced violence compared to not working in the past year (aOR = 6.12; 95% CI = 2.60-14.41). There was also evidence among boys in Nigeria (P-value for interaction = 0.045), where there was a reduction in risk of mental distress among those not in work in the past year (aOR = 0.99; 95% CI = 0.46-2.13) compared to those in work in the past year (aOR = 2.10; 95% CI = 1.32-3.33). There was also a pattern of effect modification by work in the association between childhood violence and mental health in other population groups, with variation by country, sex, and age groups. Conclusions: Our findings suggest that work can mitigate, entrench, or exacerbate risk of mental distress among young people who have experienced violence, depending on their age, sex, and country of residence. While additional research is needed to explore these mechanisms, this highlights the importance of work as a contextual factor in the lives of young people and points to the need for safe and secure workplaces and the integration of context-specific interventions into workplaces for young people.


Assuntos
Violência , Humanos , Feminino , Adolescente , Masculino , Nigéria/epidemiologia , Colômbia/epidemiologia , Adulto Jovem , Violência/estatística & dados numéricos , Violência/psicologia , Uganda/epidemiologia , Saúde Mental/estatística & dados numéricos , Inquéritos e Questionários , Maus-Tratos Infantis/estatística & dados numéricos , Maus-Tratos Infantis/psicologia , Emprego/estatística & dados numéricos
4.
Lancet Glob Health ; 12(9): e1498-e1505, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39151984

RESUMO

BACKGROUND: More than 90% of the morbidity and mortality from chronic respiratory disease occurs in low-income and middle-income countries (LMICs), with substantial economic impact. Preserved ratio impaired spirometry (PRISm) is a prevalent lung function abnormality associated with increased mortality in high-income countries. We aimed to conduct a post-hoc analysis of a cross-sectional study to assess the prevalence of, the risk factors for, and the impact of PRISm in three diverse LMIC settings. METHODS: We recruited a random, age-stratified and sex-stratified sample of the population in semi-urban Bhaktapur, Nepal; urban Lima, Peru; and rural Nakaseke, Uganda. Quality-assured post-bronchodilator spirometry was performed to American Thoracic Society standards and PRISm was defined as a forced expiratory volume in one second (FEV1) of less than 80% predicted with a FEV1/forced vital capacity ratio of 0·70 or more. We used t tests and χ2 analyses to assess the relationships between demographic, biometric, and comorbidity variables with PRISm. Multivariable logistic models with random intercept by site were used to estimate odds ratios (ORs) with 95% CIs. FINDINGS: 10 664 participants were included in the analysis, with a mean (SD) age of 56·3 (11·7) years and an equal distribution by sex. The prevalence of PRISm was 2·5% in Peru, 9·1% in Nepal, and 16·0% in Uganda. In multivariable analysis, younger age (OR for each decile of age 0·87, 95% CI 0·82-0·92) and being female (1·37, 1·18-1·58) were associated with increased odds of having PRISm. Biomass exposure was not consistently associated with PRISm across sites. Individuals with PRISm had impairment in respiratory-related quality of life as measured by the St George's Respiratory Questionnaire (OR by decile 1·18, 95% CI 1·10-1·25). INTERPRETATION: The prevalence of PRISm is heterogeneous across LMIC settings and associated with age, female sex, and biomass exposure, a common exposure in LMICs. A diagnosis of PRISm was associated with worse health status when compared with those with normal lung function. Health systems in LMICs should focus on all spirometric abnormalities as opposed to obstruction alone, given the disease burden, reduced quality of life, and size of the undiagnosed population at risk. FUNDING: Medical Research Council.


Assuntos
Países em Desenvolvimento , Espirometria , Humanos , Estudos Transversais , Feminino , Masculino , Prevalência , Adulto , Pessoa de Meia-Idade , Países em Desenvolvimento/estatística & dados numéricos , Peru/epidemiologia , Nepal/epidemiologia , Uganda/epidemiologia , Volume Expiratório Forçado , Idoso , Fatores de Risco , Adulto Jovem
5.
BMJ Open ; 14(7): e084734, 2024 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-39013652

RESUMO

OBJECTIVES: Identifying key barriers to accessing quality-assured and affordable antimicrobials among forcibly displaced persons in Uganda, Yemen and Colombia and investigating their (1) utilisation patterns of antibiotics, (2) knowledge about antimicrobial resistance (AMR) and (3) perception of the quality of antimicrobials received. DESIGN: Pilot cross-sectional survey. SETTING: Data were collected from five health facilities in the Kiryandongo refugee settlement (Bweyale, Uganda), three camps for internally displaced persons (IDPs) in the Dar Sad district (Aden, Yemen) and a district with a high population of Venezuelan migrants (Kennedy district, Bogotá, Colombia). Data collection took place between February and May 2021. The three countries were selected due to their high number of displaced people in their respective continents. PARTICIPANTS: South Sudanese refugees in Uganda, IDPs in Yemen and Venezuelan migrants in Colombia. OUTCOME MEASURE: The most common barriers to access to quality-assured and affordable antimicrobials. RESULTS: A total of 136 participants were enrolled in this study. Obtaining antimicrobials through informal pathways, either without a doctor's prescription or through family and friends, was common in Yemen (27/50, 54.0%) and Colombia (34/50, 68.0%). In Yemen and Uganda, respondents used antibiotics to treat (58/86, 67.4%) and prevent (39/86, 45.3%) a cold. Knowledge of AMR was generally low (24/136, 17.6%). Barriers to access included financial constraints in Colombia and Uganda, prescription requirements in Yemen and Colombia, and non-availability of drugs in Uganda and Yemen. CONCLUSION: Our multicentred research identified common barriers to accessing quality antimicrobials among refugees/IDPs/migrants and common use of informal pathways. The results suggest that knowledge gaps about AMR may lead to potential misuse of antimicrobials. Due to the study's small sample size and use of non-probability sampling, the results should be interpreted with caution, and larger-scale assessments on this topic are needed. Future interventions designed for similar humanitarian settings should consider the interlinked barriers identified.


Assuntos
Acessibilidade aos Serviços de Saúde , Refugiados , Humanos , Estudos Transversais , Uganda , Colômbia , Refugiados/estatística & dados numéricos , Iêmen , Projetos Piloto , Masculino , Adulto , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Adulto Jovem , Conhecimentos, Atitudes e Prática em Saúde , Antibacterianos/uso terapêutico , Antibacterianos/provisão & distribuição , Anti-Infecciosos/uso terapêutico , Adolescente
6.
BMC Oral Health ; 24(1): 709, 2024 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-38898433

RESUMO

BACKGROUND: Edentulism remains a major disability worldwide, especially among the elderly population, although the prevalence of complete edentulism has declined over the last decades. In Uganda, the prevalence of edentulism in people aged 20 years and above is 1.8%. The therapy for edentulous patients can be realized through the use of conventional removable complete dentures, implant-supported prostheses, and computer-aided design and computer-aided manufacturing (CADCAM), however, the provision of removable complete dentures continues to be the predominant rehabilitation for edentulous patients. However, no published study has explored the lived experiences with removable complete dentures among the Ugandan population. The aim of the present study was to explore patients' lived experiences on the usage of removable complete dentures among Ugandan edentulous patients attending Makerere University Dental Hospital. METHODS: This was a qualitative study approach using purposive sampling. Fifteen (15) respondents were selected across social demographics. Interviews were recorded and transcribed and themes were generated to draw a deeper meaning to the usage of removable complete dentures. A qualitative statistical package, Atlas Ti software was used to generate themes from the interviews followed by an interpretation of the generated data and the results were presented as text and in a table. RESULTS: The reported key positive experiences due to removable complete denture rehabilitation were the improvement in speech, eating ability, regaining good facial appearance, better oral hygiene management, self-esteem and confidence to smile in public, and a feeling of completeness. However, respondents complained of pain and discomfort due to the looseness of dentures, inability to eat certain foods, and regular cleaning of dentures. The respondents did not go through proper informed consent processes before getting removable complete dentures. CONCLUSION: The study found that patients were satisfied with their removable complete dentures rehabilitation due to the positive experiences registered, such as the ability to eat and talk well, and restoration of self-esteem, all of which improved their quality of life. However, they experience pain and discomfort due to the looseness of dentures.


Assuntos
Prótese Total , Boca Edêntula , Humanos , Uganda , Boca Edêntula/psicologia , Boca Edêntula/reabilitação , Feminino , Masculino , Prótese Total/psicologia , Pessoa de Meia-Idade , Idoso , Pesquisa Qualitativa , Adulto , Qualidade de Vida
7.
J Infect ; 89(1): 106173, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38734311

RESUMO

BACKGROUND: There is a need for new tools for monitoring of the response to TB treatment. Such tools may allow for tailored treatment regimens, and stratify patients initiating TB treatment into different risk groups. We evaluated combinations between previously published host biomarkers and new candidates, as tools for monitoring TB treatment response, and prediction of relapse. METHODS: Serum samples were collected at multiple time points, from patients initiating TB treatment at research sites situated in South Africa (ActionTB study), Brazil and Uganda (TBRU study). Using a multiplex immunoassay platform, we evaluated the concentrations of selected host inflammatory biomarkers in sera obtained from clinically cured patients with and without subsequent relapse within 2 years of TB treatment completion. RESULTS: A total of 130 TB patients, 30 (23%) of whom had confirmed relapse were included in the study. The median time to relapse was 9.7 months in the ActionTB study (n = 12 patients who relapsed), and 5 months (n = 18 patients who relapsed) in the TBRU study. Serum concentrations of several host biomarkers changed during TB treatment with IL-6, IP-10, IL-22 and complement C3 showing potential individually, in predicting relapse. A six-marker signature comprising of TTP, BMI, sICAM-1, IL-22, IL-1ß and complement C3, predicted relapse, prior to the onset of TB treatment with 89% sensitivity and 94% specificity. Furthermore, a 3-marker signature (Apo-CIII, IP-10 and sIL-6R) predicted relapse in samples collected at the end of TB treatment with sensitivity of 71% and specificity of 74%. A previously identified baseline relapse prediction signature (TTP, BMI, TNF-ß, sIL-6R, IL-12p40 and IP-10) also showed potential in the current study. CONCLUSION: Serum host inflammatory biomarkers may be useful in predicting relapse in TB patients prior to the initiation of treatment. Our findings have implications for tailored patient management and require prospective evaluation in larger studies.


Assuntos
Antituberculosos , Biomarcadores , Recidiva , Tuberculose Pulmonar , Humanos , Biomarcadores/sangue , Masculino , Feminino , Adulto , Tuberculose Pulmonar/sangue , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/diagnóstico , Uganda , África do Sul , Antituberculosos/uso terapêutico , Pessoa de Meia-Idade , Brasil , Adulto Jovem , Quimiocina CXCL10/sangue , Interleucinas/sangue , Citocinas/sangue , Complemento C3/análise
8.
Nat Commun ; 15(1): 1236, 2024 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-38336944

RESUMO

The mosquito-borne disease, Yellow fever (YF), has been largely controlled via mass delivery of an effective vaccine and mosquito control interventions. However, there are warning signs that YF is re-emerging in both Sub-Saharan Africa and South America. Imported from Africa in slave ships, YF was responsible for devastating outbreaks in the Caribbean. In Martinique, the last YF outbreak was reported in 1908 and the mosquito Aedes aegypti was incriminated as the main vector. We evaluated the vector competence of fifteen Ae. aegypti populations for five YFV genotypes (Bolivia, Ghana, Nigeria, Sudan, and Uganda). Here we show that mosquito populations from the Caribbean and the Americas were able to transmit the five YFV genotypes, with YFV strains for Uganda and Bolivia having higher transmission success. We also observed that Ae. aegypti populations from Martinique were more susceptible to YFV infection than other populations from neighboring Caribbean islands, as well as North and South America. Our vector competence data suggest that the threat of re-emergence of YF in Martinique and the subsequent spread to Caribbean nations and beyond is plausible.


Assuntos
Aedes , Febre Amarela , Animais , Humanos , Vírus da Febre Amarela/genética , Mosquitos Vetores , Índias Ocidentais , Região do Caribe/epidemiologia , Uganda
9.
J Pediatr ; 269: 113983, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38401789

RESUMO

OBJECTIVE: To examine the preliminary impact of group cognitive behavioral therapy and multiple family group-based family strengthening to address HIV stigma and improve the mental health functioning of adolescents living with HIV in Uganda. STUDY DESIGN: We analyzed data from the Suubi4Stigma study, a 2-year pilot randomized clinical trial that recruited adolescents living with HIV (10-14 years) and their caregivers (n = 89 dyads), from 9 health clinics. We fitted separate three-level mixed-effects linear regression models to test the effect of the interventions on adolescent outcomes at 3 and 6 months post intervention initiation. RESULTS: The average age was 12.2 years and 56% of participants were females. Participants in the multiple family group-based family strengthening intervention reported lower levels of internalized stigma (mean difference = -0.008, 95% CI = -0.015, -0.001, P = .025) and depressive symptoms at 3 months (mean difference = -0.34, 95% CI = -0.53, -0.14, P < .001), compared with usual care. On the other hand, participants in the group cognitive behavioral therapy intervention reported lower levels of anticipated stigma at 3 months (mean difference = -0.039, 95% CI = -0.072, -0.006), P = .013) and improved self-concept at 6 months follow-up (mean difference = 0.04, 95% CI = 0.01, 0.01, P = .025). CONCLUSION: Outcome trends from this pilot study provide compelling evidence to support testing the efficacy of these group-based interventions on a larger scale. TRIAL REGISTRATION: The study is registered in the Clinical trials.gov database (Identifier #: NCT04528732).


Assuntos
Terapia Cognitivo-Comportamental , Infecções por HIV , Psicoterapia de Grupo , Estigma Social , Humanos , Feminino , Masculino , Adolescente , Uganda , Infecções por HIV/psicologia , Infecções por HIV/terapia , Criança , Projetos Piloto , Terapia Cognitivo-Comportamental/métodos , Psicoterapia de Grupo/métodos , Saúde Mental , Cooperação e Adesão ao Tratamento/psicologia , Cuidadores/psicologia
10.
BMC Prim Care ; 24(1): 241, 2023 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-37968592

RESUMO

INTRODUCTION: The management of long-term physical conditions is a challenge worldwide, absorbing a majority resources despite the importance of acute care. The management of these conditions is done largely in primary care and so interventions to improve primary care could have an enormous impact. However, very little data exist on how to do this. Mental distress is frequently comorbid with long term physical conditions, and can impact on health behaviour and adherence, leading to poorer outcomes. DIALOG+ is a low-cost, patient-centred and solution-focused intervention, which is used in routine patient-clinician meetings and has been shown to improve outcomes in mental health care. The question arises as to whether it could also be used in primary care to improve the quality of life and mental health of patients with long-term physical conditions. This is particularly important for low- and middle-income countries with limited health care resources. METHODS: An exploratory non-controlled multi-site trial was conducted in Bosnia and Herzegovina, Colombia, and Uganda. Feasibility was determined by recruitment, retention, and session completion. Patient outcomes (quality of life, anxiety and depression symptoms, objective social situation) were assessed at baseline and after three approximately monthly DIALOG+ sessions. RESULTS: A total of 117 patients were enrolled in the study, 25 in Bosnia and Herzegovina, 32 in Colombia, and 60 in Uganda. In each country, more than 75% of anticipated participants were recruited, with retention rates over 90% and completion of the intervention exceeding 92%. Patients had significantly higher quality of life and fewer anxiety and depression symptoms at post-intervention follow-up, with moderate to large effect sizes. There were no significant improvements in objective social situation. CONCLUSION: The findings from this exploratory trial suggest that DIALOG+ is feasible in primary care settings for patients with long-term physical conditions and may substantially improve patient outcomes. Future research may test implementation and effectiveness of DIALOG+ in randomized controlled trials in wider primary care settings in low- and middle-income countries. TRIAL REGISTRATION: All studies were registered prospectively within the ISRCTN Registry. ISRCTN17003451, 02/12/2020 (Bosnia and Herzegovina), ISRCTN14018729, 01/12/2020 (Colombia) and ISRCTN50335796, 02/12/2020 (Uganda).


Assuntos
Atenção Primária à Saúde , Qualidade de Vida , Humanos , Bósnia e Herzegóvina , Colômbia/epidemiologia , Uganda/epidemiologia , Estudos de Viabilidade
11.
Am J Respir Crit Care Med ; 208(4): 442-450, 2023 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-37369142

RESUMO

Rationale: Chronic obstructive pulmonary disease (COPD) is a prevalent and burdensome condition in low- and middle-income countries (LMICs). Challenges to better care include more effective diagnosis and access to affordable interventions. There are no previous reports describing therapeutic needs of populations with COPD in LMICs who were identified through screening. Objectives: To describe unmet therapeutic need in screening-detected COPD in LMIC settings. Methods: We compared interventions recommended by the international Global Initiative for Chronic Obstructive Lung Disease COPD strategy document, with that received in 1,000 people with COPD identified by population screening at three LMIC sites in Nepal, Peru, and Uganda. We calculated costs using data on the availability and affordability of medicines. Measurement and Main Results: The greatest unmet need for nonpharmacological interventions was for education and vaccinations (applicable to all), pulmonary rehabilitation (49%), smoking cessation (30%), and advice on biomass smoke exposure (26%). Ninety-five percent of the cases were previously undiagnosed, and few were receiving therapy (4.5% had short-acting ß-agonists). Only three of 47 people (6%) with a previous COPD diagnosis had access to drugs consistent with recommendations. None of those with more severe COPD were accessing appropriate maintenance inhalers. Even when available, maintenance treatments were unaffordable, with 30 days of treatment costing more than a low-skilled worker's daily average wage. Conclusions: We found a significant missed opportunity to reduce the burden of COPD in LMIC settings, with most cases undiagnosed. Although there is unmet need in developing novel therapies, in LMICs where the burden is greatest, better diagnosis combined with access to affordable interventions could translate to immediate benefit.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Abandono do Hábito de Fumar , Humanos , Países em Desenvolvimento , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Uganda , Peru
12.
Ann N Y Acad Sci ; 1526(1): 84-98, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37391187

RESUMO

Adequate calcium intake is essential for health, especially for infants, children, adolescents, and women, yet is difficult to achieve with local foods in many low- and middle-income countries. Previous analysis found it was not always possible to identify food-based recommendations (FBRs) that reached the calcium population recommended intake (PRI) for these groups in Bangladesh, Guatemala, and Uganda. We have modeled the potential contribution of calcium-fortified drinking water or wheat flour to FBR sets, to fill the remaining intake gaps. Optimized diets containing fortified products, with calcium-rich local foods, achieved the calcium PRI for all target groups. Combining fortified water or flour with FBRs met dietary intake targets for adolescent girls in all geographies and allowed a reduction from 3-4 to the more feasible 1-2 FBRs. Water with a calcium concentration of 100 mg/L with FBRs was sufficient to meet calcium targets in Uganda, but higher concentrations (400-500 mg/L) were mostly required in Guatemala and Bangladesh. Combining calcium-fortified wheat flour at 400 mg/100 g of flour and the FBR for small fish resulted in diets meeting the calcium PRI in Bangladesh. Calcium-fortified water or flour could improve calcium intake for vulnerable populations, especially when combined with FBRs based on locally available foods.


Assuntos
Cálcio da Dieta , Farinha , Alimentos Fortificados , Bangladesh , Cálcio , Dieta , Guatemala , Triticum , Uganda , Água , Humanos , Feminino , Adolescente , Adulto , Pré-Escolar , Criança
13.
Ann N Y Acad Sci ; 1525(1): 173-183, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37230491

RESUMO

Globally, dietary intake of calcium is often insufficient, and it is unclear if adequacy could be achieved by promoting calcium-rich local foods. This study used linear programming and household consumption data from Uganda, Bangladesh, and Guatemala to assess whether local foods could meet calcium population reference intakes (Ca PRIs). The most promising food-based approaches to promote dietary calcium adequacy were identified for 12- to 23-month-old breastfed children, 4- to 6-year-old children, 10- to 14-year-old girls, and nonpregnant and nonbreastfeeding (NPNB) women of reproductive age living in two regions of each country. Calcium-optimized diets achieved 75-253% of the Ca PRI, depending on the population, and were <100% for 4- to 6-year-olds in one region of each country and 10- to 14-year-old girls in Sylhet, Bangladesh. The best food sources of calcium were green leafy vegetables and milk, across geographic locations, and species of small fish, nixtamalized (lime-treated) maize products, sesame seeds, and bean varieties, where consumed. Food-based recommendations (FBRs) achieving the minimum calcium threshold were identified for 12- to 23-month-olds and NPNB women across geographic locations, and for 4- to 6-year-olds and 10-to 14-year-old girls in Uganda. However, for 4- to 6-year-olds and 10- to 14-year-old girls in Bangladesh and Guatemala, calcium-adequate FBRs could not be identified, indicating a need for alternative calcium sources or increased access to and consumption of local calcium-rich foods.


Assuntos
Cálcio , Dieta , Criança , Animais , Humanos , Feminino , Lactente , Pré-Escolar , Adolescente , Bangladesh , Populações Vulneráveis , Guatemala , Uganda , Cálcio da Dieta
14.
BMC Pregnancy Childbirth ; 23(1): 172, 2023 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-36915061

RESUMO

BACKGROUND: There is an urgent need for active safety surveillance to monitor vaccine exposure during pregnancy in low- and middle-income countries (LMICs). Existing maternal, newborn, and child health (MNCH) data collection systems could serve as platforms for post-marketing active surveillance of maternal immunization safety. To identify sites using existing systems, a thorough assessment should be conducted. Therefore, this study had the objectives to first develop an assessment tool and then to pilot this tool in sites using MNCH data collection systems through virtual informant interviews. METHODS: We conducted a rapid review of the literature to identify frameworks on population health or post-marketing drug surveillance. Four frameworks that met the eligibility criteria were identified and served to develop an assessment tool capable of evaluating sites that could support active monitoring of vaccine safety during pregnancy. We conducted semi-structured interviews in six geographical sites using MNCH data collection systems (DHIS2, INDEPTH, and GNMNHR) to pilot domains included in the assessment tool. RESULTS: We developed and piloted the "VPASS (Vaccines during Pregnancy - sites supporting Active Safety Surveillance) assessment tool" through interviews with nine stakeholders, including central-level systems key informants and site-level managers from DHIS2 and GNMNHR; DHIS2 in Kampala (Uganda) and Kigali (Rwanda); GNMNHR from Belagavi (India) and Lusaka (Zambia); and INDEPTH from Nanoro (Burkina Faso) and Manhica (Mozambique). The tool includes different domains such as the system's purpose, the scale of implementation, data capture and confidentiality, type of data collected, the capability of integration with other platforms, data management policies and data quality monitoring. Similarities among sites were found regarding some domains, such as data confidentiality, data management policies, and data quality monitoring. Four of the six sites met some domains to be eligible as potential sites for active surveillance of vaccinations during pregnancy, such as a routine collection of MNCH individual data and the capability of electronically integrating individual MNCH outcomes with information related to vaccine exposure during pregnancy. Those sites were: Rwanda (DHIS2), Manhica (IN-DEPTH), Lusaka (GNMNHR), and Belagavi (GNMNHR). CONCLUSION: This study's findings should inform the successful implementation of active safety surveillance of vaccines during pregnancy by identifying and using active individual MNCH data collection systems in LMICs.


Assuntos
Países em Desenvolvimento , Vacinas , Gravidez , Recém-Nascido , Criança , Feminino , Humanos , Zâmbia , Ruanda , Uganda , Vacinas/efeitos adversos , Confiabilidade dos Dados
15.
J Relig Health ; 62(3): 2196-2212, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36242707

RESUMO

Violence, abuse and neglect constitute major threats to children's health and wellbeing globally. However, until recently, relatively little systematic attention has been paid to the role of faith communities in shaping the protective environment for children. This paper describes the development of a measure to capture child-protective disposition amongst faith communities through field studies with faith leaders and their spouses in Senegal, Uganda and Guatemala. Identifying common factors related to child care and protection practices, orientation to child rights and approaches to discipline, the measure potentially serves to both inform and evaluate interventions seeking to engage with the beliefs and behaviours of faith communities to support children's health and wellbeing.


Assuntos
Maus-Tratos Infantis , Cônjuges , Humanos , Criança , Uganda , Guatemala , Senegal , Maus-Tratos Infantis/prevenção & controle
16.
J Pediatr ; 257: 113271, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36402433

RESUMO

OBJECTIVES: To assess the cognitive capacity of early, middle, and late adolescents and their parents or guardians to provide informed consent to a population-based cohort study. STUDY DESIGN: Adolescent-parent/guardian dyads including 40 early (n = 80; 10-14 years), 20 middle (15-17 years), and 20 late (18-19 years) adolescents were recruited from the Rakai Community Cohort Study, an open demographic cohort in Uganda. Participants were administered the MacArthur Competence Assessment Tool for Clinical Research, a structured open-ended assessment; interviews were recorded and transcribed. Twenty transcripts were scored independently by two coders; the intraclass correlation coefficient was 0.89. The remaining interviews were scored individually. We compared mean scores for early and middle/late adolescents using a one-sided t test and score differences between parent/guardian and adolescent dyads using two-sided paired t tests. RESULTS: Early adolescents (mean score, 28.8; 95% CI, 27.1-30.5) scored significantly lower (P < .01) than middle/late adolescents (32.4; 31.6-33.1). In paired dyad comparisons, we observed no statistically significant difference in scores between parents/guardians and middle/late adolescents (difference, -0.2; 95% CI, -1.0-0.6). We found a statistically significant difference in scores between parents/guardians and early adolescents (difference, 3.0; 95% CI, 1.2-4.8). CONCLUSIONS: The capacity of adolescents-of different ages and in diverse settings-to comprehend risks, benefits, and other elements of informed consent is a critical but understudied area in research ethics. Our findings support the practice of having middle and late adolescents provide independent informed consent for sexual and reproductive health studies. Early adolescents may benefit from supported decision-making approaches.


Assuntos
Consentimento Livre e Esclarecido , Competência Mental , Humanos , Adolescente , Competência Mental/psicologia , Estudos de Coortes , Uganda , Consentimento Livre e Esclarecido/psicologia , Pais , Tomada de Decisões
17.
Bull. W.H.O. (Print) ; 101(10): 626-636, 2023.
Artigo em Inglês | AIM (África), Sec. Est. Saúde SP | ID: biblio-1515920

RESUMO

Objective To evaluate resource allocation and costs associated with delivery of human immunodeficiency virus (HIV) services in Uganda and the United Republic of Tanzania. Methods We used time-driven activity-based costing to determine the resources consumed and costs of providing five HIV services in Uganda and the United Republic of Tanzania: antiretroviral therapy (ART); HIV testing and counselling; prevention of mother-to-child transmission; voluntary male medical circumcision; and pre-exposure prophylaxis. Findings Country-based teams undertook time-driven activity-based costing with 1119 adults in Uganda and 886 adults in the United Republic of Tanzania. In Uganda, service delivery costs ranged from 8.18 United States dollars (US$) per visit for HIV testing and counselling to US$ 43.43 for ART (for clients in whom HIV was suppressed). In the United Republic of Tanzania, these costs ranged from US$ 3.67 per visit for HIV testing and counselling to US$ 28.00 for voluntary male medical circumcision. In both countries, consumables were the main cost driver, accounting for more than 60% of expenditure. Process maps showed that in both countries, registration, measurement of vital signs, consultation and medication dispensing were the steps that occurred most frequently for ART clients. Conclusion Establishing a rigorous, longitudinal system for tracking investments in HIV services that includes thousands of clients and numerous facilities is achievable in different settings with a high HIV burden. Consistent engagement of implementation partners and standardized training and data collection instruments proved essential for the success of these exercise


Assuntos
Infecções por HIV , Tanzânia , Uganda , Terapia Antirretroviral de Alta Atividade
18.
PLoS One ; 17(12): e0279236, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36542631

RESUMO

INTRODUCTION: Automated mobile phone surveys (MPS) can be used to collect public health data of various types to inform health policy and programs globally. One challenge in administering MPS is identification of an appropriate and effective participant consent process. This study investigated the impact of different survey consent approaches on participant disposition (response characteristics and understanding of the purpose of the survey) within the context of an MPS that measured noncommunicable disease (NCD) risk factors across Colombia and Uganda. METHODS: Participants were randomized to one of five consent approaches, with consent modules varying by the consent disclosure and mode of authorization. The control arm consisted of a standard consent disclosure and a combined opt-in/opt-out mode of authorization. The other four arms consist of a modified consent disclosure and one of four different forms of authorization (i.e., opt-in, opt-out, combined opt-in/opt-out, or implied). Data related to respondent disposition and respondent understanding of the survey purpose were analyzed. RESULTS: Among 1889 completed surveys in Colombia, differences in contact, response, refusal, and cooperation rates by study arms were found. About 68% of respondents correctly identified the survey purpose, with no significant difference by study arm. Participants reporting higher levels of education and urban residency were more likely to identify the purpose correctly. Participants were also more likely to accurately identify the survey purpose after completing several survey modules, compared to immediately following the consent disclosure (78.8% vs 54.2% correct, p<0.001). In Uganda, 1890 completed surveys were collected. Though there were differences in contact, refusal, and cooperation rates by study arm, response rates were similar across arms. About 37% of respondents identified the survey purpose correctly, with no difference by arm. Those with higher levels of education and who completed the survey in English were able to more accurately identify the survey purpose. Again, participants were more likely to accurately identify the purpose of the survey after completing several NCD modules, compared to immediately following the consent module (42.0% vs 32.2% correct, p = 0.013). CONCLUSION: This study contributes to the limited available evidence regarding consent procedures for automated MPS. Future studies should develop and trial additional interventions to enhance consent for automated public health surveys, and measure other dimensions of participant engagement and understanding.


Assuntos
Telefone Celular , Doenças não Transmissíveis , Humanos , Uganda , Colômbia , Inquéritos e Questionários , Fatores de Risco , Consentimento Livre e Esclarecido
19.
Health Hum Rights ; 24(2): 29-45, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36579320

RESUMO

Gender-based violence (GBV) is a violation of human rights and must be addressed as such. This paper examines whether donor practices align with a rights-based approach, using data from our comprehensive study of foreign funding flows related to GBV in Colombia, Kenya, and Uganda from 2010 to 2020. By analyzing data from 1,180 grants-and providing parallel analyses of the state of GBV, and GBV reporting and interventions in each country-we demonstrate donors' role in shaping GBV outcomes and their consequent duty to address policies and practices that violate rights. Accordingly, we propose changes in donor practices to promote realization of the right to freedom from violence.


Assuntos
Violência de Gênero , Humanos , Quênia , Direitos Humanos , Uganda , Colômbia
20.
BMJ Open ; 12(5): e055218, 2022 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-35613750

RESUMO

INTRODUCTION: Attainment of universal health coverage is feasible via strengthened primary health systems that are comprehensive, accessible, people-centred, continuous and coordinated. Having an adequately trained, motivated and equipped primary healthcare workforce is central to the provision of comprehensive primary healthcare (CPHC). This study aims to understand PHC team integration, composition and organisation in the delivery of CPHC in India, Mexico and Uganda. METHODS AND ANALYSIS: A parallel, mixed-methods study (integration of quantitative and qualitative results) will be conducted to gain an understanding of PHC teams. Methods include: (1) Policy review on PHC team composition, organisation and expected comprehensiveness of PHC services, (2) PHC facility review using the WHO Service Availability and Readiness Assessment, and (3) PHC key informant interviews. Data will be collected from 20, 10 and 10 PHCs in India, Mexico and Uganda, respectively, and analysed using descriptive methods and thematic analysis approach. Outcomes will include an in-depth understanding of the health policies for PHC as well as understanding PHC team composition, organisation and the delivery of comprehensive PHC. ETHICS AND DISSEMINATION: Approvals have been sought from the Institutional Ethics Committee of The George Institute for Global Health, India for the Indian sites, School of Medicine Research Ethics Committee at Makerere University for the sites in Uganda and the Research, Ethics and Biosecurity Committees of the Mexican National Institute of Public Health for the sites in Mexico. Results will be shared through presentations with governments, publications in peer-reviewed journals and presentations at conferences.


Assuntos
Países em Desenvolvimento , Atenção Primária à Saúde , Humanos , Índia , México , Uganda
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