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1.
BMC Public Health ; 23(1): 23, 2023 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-36600216

RESUMO

At the height of the COVID-19 pandemic, gender-based violence (GBV) was reported to have increased worldwide. We build on existing literature to examine the factors that increased vulnerability to GBV during the COVID-19 pandemic in Uganda. We use data from the Rapid Gender Assessment (RGA) survey that was conducted during COVID-19, which was designed to provide information to guide policymaking and offer appropriate interventions that address the needs of people in Uganda during the pandemic. The results show that the following respondents are more likely to experience increased risk and vulnerability to gender-based violence: those with primary level of education (OR = 1.49; 95% CI = 1.10-2.01), those who received information about GBV (OR = 1.30; 95% CI = 1.08-1.57), and those who needed help or medical support as a prevention measure against GBV (OR = 1.29; 95% CI = 1.04-1.61). However, respondents who would need financial support to prevent GBV were less likely to experience increased GBV (OR = 0.83; 95% CI = 0.70-0.98). Our results align with evidence from other studies that risk and vulnerability to GBV in Uganda increased since the onset of COVID-19. The findings provide an understanding of the interrelationship between GBV and COVID-19,which can help with designing GBV preventive measures, particularly during pandemics among those most at-risk.


Assuntos
COVID-19 , Violência de Gênero , Humanos , Feminino , Uganda/epidemiologia , Pandemias , COVID-19/epidemiologia , Violência
2.
BMC Health Serv Res ; 23(1): 59, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36670448

RESUMO

BACKGROUND: Despite facing a dual burden of HBV and HIV, Africa lacks experience in offering integrated care for HIV and HBV. To contextualize individual and group-level feasibility and acceptability of an integrated HIV/HBV care model, we explored perspectives of health care providers and care recipients on feasibility and acceptability of integration. METHODS: In two regional hospitals of West Nile region, we performed a demonstration project to assess feasibility and acceptability of merging the care of HBV-monoinfected patients with existing HIV care system. Using interviews with health care providers as key informants, and 6 focus groups discussions with 3 groups of patients, we explored feasibility [(i)whether integration is perceived to fit within the existing healthcare infrastructure, (ii) perceived ease of implementation of HIV/HBV integrated care, and (iii) perceived sustainability of integration] and acceptability [whether the HIV/HBV care model is perceived as (i) suitable, (ii) satisfying and attractive (iii) there is perceived demand, need and intention to recommend its use]. We audio-recorded the interviews and data was analysed using framework analysis. RESULTS: The following themes emerged from the data (i) integrating HBV into HIV care is perceived to be feasible, fit and beneficial, after making requisite adjustments (ii) integration is acceptable due to the need for both free treatment and anticipated collaboration between HIV and HBV clients in terms of peer-support (iii) there are concerns about the likely rise in stigma and the lack of community awareness about integrated care. CONCLUSION: The integrated HIV/HBV care model is feasible and acceptable among both providers and recipients. Necessary adjustments to the existing care system, including training, for community sensitization on the reasons and significance of integration are required.


Assuntos
Infecções por HIV , Hepatite B , Humanos , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Uganda/epidemiologia , Estudos de Viabilidade , Hepatite B/terapia , Pessoal de Saúde
3.
Soc Sci Med ; 318: 115471, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36628879

RESUMO

BACKGROUND: Population mobility is prevalent and complex in sub-Saharan Africa, and can disrupt HIV care and fuel onward transmission. While differentiated care models show promise for meeting the needs of mobile populations by addressing care cascade gaps, the voices of mobile populations need to be included when designing care delivery models. We assessed the unmet needs of mobile populations and engaged mobile stakeholders in the design and implementation of service delivery to improve care outcomes for mobile people living with HIV (PLHIV). METHODS: CBPR was conducted in 12 rural communities in Kenya and Uganda participating in a mobility study within the Sustainable East Africa Research in Community Health (SEARCH) test-and-treat trial (NCT# 01864603) from 2016 to 2019. Annual gender-balanced meetings with between 17 and 33 mobile community stakeholders per meeting were conducted in local languages to gather information on mobility and its influence on HIV-related outcomes. Discussions were audio-recorded, transcribed and translated into English. Findings were shared at subsequent meetings to engage mobile stakeholders in interpretation. At year three, intervention ideas to address mobile populations' needs were elicited. After refinement, these intervention options were presented to the same communities for prioritization the following year, using a participatory ranking approach. RESULTS: Transit hubs, trading centers, and beach sites were identified as desirable service locations. Communities prioritized mobile health 'cards' with electronic medical records and peer-delivered home-based services. Mobile health clinics, longer antiretroviral refills, and 24/7 (after service) were less desirable options. Care challenges included: lack of transfer letters to other clinics; inability to adhere to scheduled appointments, medication regimens, and monitoring of treatment outcomes while mobile amongst others. CONCLUSIONS: Iterative discussions with mobile community stakeholders elicited communities' health priorities and identified challenges to achieving HIV care cascade outcomes. Understanding the mobility patterns and unique needs of mobile populations through responsive community engagement is critical.


Assuntos
Infecções por HIV , Humanos , Infecções por HIV/epidemiologia , Pesquisa Participativa Baseada na Comunidade , Quênia/epidemiologia , Uganda/epidemiologia , Atenção à Saúde
4.
Trop Anim Health Prod ; 55(1): 44, 2023 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-36689063

RESUMO

BACKGROUND: This study investigated the spatial distribution of wild ungulates that pastoralist communities perceive as culprits in the transmission of cattle diseases outside protected areas in southwestern Uganda. Diseases are hypothesized as having influence on pastoralists' choice of cattle breed types. Until now, there have been no studies conducted on spatial patterns of wild animal species association with cattle breeds reared in Lake Mburo Conservation Area (LMCA), and how diseases transmitted therein potentially influence cattle breed herd sizes. METHODS: Animal population survey was carried out on cattle and wild ungulate species along transect lines laid perpendicular to the northern boundary of Lake Mburo National Park (LMNP). Data on the costs of cattle mortality and disease control were gathered using face-to-face interviews. We used SPSS version 17 for descriptive statistics to summarize unit cost of disease control at herd level, whereas chi-square (χ2) tests of goodness-of-fit were used to analyze observations on frequency of wild animal sightings, whose association with spatial distribution patterns of cattle breeds was examined using Pearson correlation test. RESULTS: Our results show inverse association of distance away from LMNP with wild animal populations and the cost of cattle disease control. The mean population of exotic cattle significantly increased as that of indigenous cattle decreased with increasing distance from LMNP. In a similar way, the cost of disease control and cattle abortion incidences were much lower in rangelands far away from LMNP (R2 = 0.965, p < 0.001). CONCLUSION: Spatial distribution of wild ungulates was significantly associated with reported cattle mortality, disease, and cost of disease control. Diseases and their costs of control potentially influenced spatial patterns of cattle breeds and breed herd sizes in LMCA, which in turn could affect range resource use for conserving different species of wild animals outside protected area.


Assuntos
Animais Selvagens , Doenças dos Bovinos , Feminino , Gravidez , Animais , Bovinos , Uganda/epidemiologia , Doenças dos Bovinos/epidemiologia , Inquéritos e Questionários
5.
BMC Psychol ; 11(1): 5, 2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36624544

RESUMO

BACKGROUND: Psychological distress among adolescents negatively affects their academic performance, relationships with family and friends, and ability to participate fully in the community. Stressful life events in low-income countries and risk-taking behavior of adolescents have raised concerns regarding the impact of psychological distress among adolescents. Therefore, the present study estimated the prevalence of psychological distress and examined the high-risk behaviors associated with psychological distress among Ugandan adolescents. METHODS: A community based cross-sectional study was conducted among secondary school students in Mbarara Municipality, Uganda. Multistage cluster sampling was used to recruit 921 adolescents from 12 schools. Psychological distress was assessed using the 10-item Kessler Psychological Distress Scale (K10). Logistic regression was used with p-value estimating regression coefficient and 95% confidence interval for odds ratio and adjusted odds ratio (AOR). RESULTS: The prevalence of psychological distress using the K10 was 57%. Logistic regression analyses showed that risky sexual behavior [AOR = 1.52; 95% confidence interval (CI) 1.02-2.28], substance use (AOR = 2.06; 95% CI 1.49-2.84) were associated with psychological distress. Students in mixed schools (comprising both sexes) (AOR = 1.94; 95% CI 1.19-3.15) and adolescents with chronic illness (AOR = 1.68; 95% CI 1.18-2.38) were more likely to report psychological distress. CONCLUSION: The prevalence of psychological distress among school-going adolescents is high. Risky sexual behavior, substance use as well as chronic illness were associated with psychological distress. In addition, the type of school was significantly associated with psychological distress. The findings suggest the need for policy makers and stakeholders in health and education sectors to institute measures that will address mental health issues among adolescents.


Assuntos
Angústia Psicológica , Assunção de Riscos , Feminino , Masculino , Adolescente , Humanos , Uganda/epidemiologia , Prevalência , Estudos Transversais , Instituições Acadêmicas , Estudantes
6.
PLoS One ; 18(1): e0266795, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36652459

RESUMO

HIV prevalence among the general population in South Sudan, the world's newest country, is estimated at 2.9% and in Nimule, a town at the border with Uganda, it is estimated at 7.5%. However, there is limited data describing the HIV epidemic among female sex workers and sexually exploited adolescents (FSW/SEA) in the country. This study was conducted using a respondent-driven sampling (RDS) among FSW/SEA aged ≥15 years in January-February 2017 who sold or exchanged sex in the last six months in Nimule. Consenting participants were administered a questionnaire and tested for HIV according to the national algorithm. Syphilis testing was conducted using SD BIOLINE Syphilis 3.0 and Rapid Plasma Reagin for confirmation. Data were analyzed in SAS and RDS-Analyst and weighted results are presented. The 409 FSW/SEA participants with a median age of 28 years (IQR 23-35) and a median age of 23 years (IQR 18-28) when they entered the world of sex work, were enrolled in the Eagle survey. Nearly all (99.2%) FSW/SEA lacked comprehensive knowledge of HIV though almost half (48.5%) talked to a peer educator or outreach worker about HIV in the last 30 days. More than half (55.3%) were previously tested for HIV. Only 46.4% used a condom during their last vaginal or anal sexual act with a client. One in five (19.8%) FSW/SEA experienced a condom breaking during vaginal or anal sex in the last six months HIV prevalence was 24.0% (95% CI: 19.4-28.5) and 9.2% (95% CI: 6.5-11.9) had active syphilis. The multivariable analysis revealed the association between HIV and active syphilis (aOR: 6.99, 95% CI: 2.23-21.89). HIV and syphilis prevalence were higher among FSW/SEA in Nimule than the general population in the country and Nimule. Specifically, the HIV prevalence was eight times higher than the general population. Our findings underscore the importance of providing HIV and syphilis testing for FSW/SEA in conjunction with comprehensive combination prevention, including comprehensive HIV information, promotion of condom use, and availing treatment services for both HIV and syphilis.


Assuntos
Infecções por HIV , Profissionais do Sexo , Sífilis , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Sífilis/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Prevalência , Uganda/epidemiologia , Sudão do Sul/epidemiologia , Comportamento Sexual
7.
BMC Public Health ; 23(1): 129, 2023 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-36653836

RESUMO

BACKGROUND: Studies in various countries including Uganda and Kenya have shown a much lower incidence of the human immunodeficiency virus (HIV) among men that underwent voluntary medical male circumcision (VMMC) compared to uncircumcised men. Wakiso district, the district with the highest prevalence of HIV in Uganda (7%), has a very low estimated proportion of men who have undergone VMMC (30.5%). Within the district, various public health facilities provide free VMMC services. This study examined the prevalence and factors associated with the uptake of VMMC among men attending the outpatient department (OPD) of a public facility offering VMMC services. METHODS: We conducted a cross-sectional study between July to August 2021 using a sample of men attending the OPD at Kira Health Centre IV. We defined VMMC uptake as the removal of all or part of the foreskin of the penis by a trained healthcare professional. We determined factors independently associated with VMMC uptake using a modified Poisson regression analysis with robust standard errors at a 5% statistical significance level. Adjusted prevalence risk ratios (APRR) were reported as the measure of outcome. RESULTS: Overall, 389 participants were enrolled in the study. The mean age of the participants was 27.2 (standard deviation ± 9.02) years. The prevalence of VMMC uptake was 31.4% (95% Confidence Interval [CI] 26.8-36.2). In the adjusted analysis, the uptake of VMMC among men attending the OPD of Kira HC IV was less likely among married participants compared to unmarried participants (APRR 0.64, 95% CI 0.48-0.88), among participants from Western tribes (APRR 0.50, 95% CI 0.41-0.86) or Eastern tribes (APPR 0.31, 95% CI 0.13-0.72) compared to participants from the Central tribes and among participants who didn't disclose their sexual partner number compared to those that had one or no sexual partner (APRR 0.62, 95% CI 0.40-0.97). On the other hand, the prevalence of uptake of VMMC was 7 times among participants who were aware of VMMC compared to those who were not aware of VMMC (APRR 7.85 95% CI 1.07-9.80) and 2.7 times among participants who knew their HIV status compared to those that didn't know (APRR 2.75, 95% CI 1.85-4.0). Also, the uptake of VMMC was 85% more among participants who knew that Kira HC IV provided free VMMC services compared to those that didn't (APRR 1.85, 95% CI 1.85-4.08). CONCLUSION: VMMC among men attending the OPD at the largest public healthcare facility proving free VMMC services in Kira Municipality was low. The OPD may provide a quick win for improving VMMC uptake. Collaborative efforts among the administration of Kira HC IV, the Ministry of Health and VMMC implementation partners could work towards developing health-facility-based strategies that can improve VMMC awareness and uptake with emphasis on the OPD.


Assuntos
Circuncisão Masculina , Infecções por HIV , Humanos , Masculino , Uganda/epidemiologia , Estudos Transversais , Pacientes Ambulatoriais , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Instalações de Saúde
8.
J Glob Health ; 13: 06003, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36655920

RESUMO

Background: COVID-19-related lockdowns and other public health measures may have differentially affected the quality of life (QOL) of older people with and without human immunodeficiency virus (HIV) in rural Uganda. Methods: The Quality of Life and Aging with HIV in Rural Uganda study enrolled people with and without HIV aged over 49 from October 2020 to October 2021. We collected data on COVID-19-related stressors (behavior changes, concerns, interruptions in health care, income, and food) and the participants' QOL. We used linear regression to estimate the associations between COVID-19-related stressors and QOL, adjusting for demographic characteristics, mental and physical health, and time before vs after the lockdown during the second COVID-19 wave in Uganda. Interaction between HIV and COVID-19-related stressors evaluated effect modification. Results: We analyzed complete data from 562 participants. Mean age was 58 (standard deviation (SD) = 7); 265 (47%) participants were female, 386 (69%) were married, 279 (50%) had HIV, and 400 (71%) were farmers. Those making ≥5 COVID-19-related behavior changes compared to those making ≤2 had worse general QOL (estimated linear regression coefficient (b) = - 4.77; 95% confidence interval (CI) = -6.61, -2.94) and health-related QOL (b = -4.60; 95% CI = -8.69, -0.51). Having access to sufficient food after the start of the COVID-19 pandemic (b = 3.10, 95% CI = 1.54, 4.66) and being interviewed after the start of the second lockdown (b = 2.79, 95% CI = 1.30, 4.28) were associated with better general QOL. Having HIV was associated with better health-related QOL (b = 5.67, 95% CI = 2.91,8.42). HIV was not associated with, nor did it modify the association of COVID-19-related stressors with general QOL. Conclusions: In the context of the COVID-19 pandemic in an HIV-endemic, low-resource setting, there was reduced QOL among older Ugandans making multiple COVID-19 related behavioral changes. Nonetheless, good QOL during the second COVID-19 wave may suggest resilience among older Ugandans.


Assuntos
COVID-19 , Infecções por HIV , Humanos , Feminino , Idoso , Pessoa de Meia-Idade , Masculino , Qualidade de Vida , HIV , Estudos Transversais , Uganda/epidemiologia , Pandemias , Infecções por HIV/epidemiologia , COVID-19/complicações , Controle de Doenças Transmissíveis
9.
Proc Natl Acad Sci U S A ; 120(2): e2211055120, 2023 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-36595676

RESUMO

Endemic Burkitt lymphoma (eBL) is a pediatric cancer coendemic with malaria in sub-Saharan Africa, suggesting an etiological link between them. However, previous cross-sectional studies of limited geographic areas have not found a convincing association. We used spatially detailed data from the Epidemiology of Burkitt Lymphoma in East African Children and Minors (EMBLEM) study to assess this relationship. EMBLEM is a case-control study of eBL from 2010 through 2016 in six regions of Kenya, Uganda, and Tanzania. To measure the intensity of exposure to the malaria parasite, Plasmodium falciparum, among children in these regions, we used high-resolution spatial data from the Malaria Atlas Project to estimate the annual number of P. falciparum infections from 2000 through 2016 for each of 49 districts within the study region. Cumulative P. falciparum exposure, calculated as the sum of annual infections by birth cohort, varied widely, with a median of 47 estimated infections per child by age 10, ranging from 4 to 315 infections. eBL incidence increased 39% for each 100 additional lifetime P. falciparum infections (95% CI: 6.10 to 81.04%) with the risk peaking among children aged 5 to 11 and declining thereafter. Alternative models using estimated annual P. falciparum infections 0 to 10 y before eBL onset were inconclusive, suggesting that eBL risk is a function of cumulative rather than recent cross-sectional exposure. Our findings provide population-level evidence that eBL is a phenotype related to heavy lifetime exposure to P. falciparum malaria and support emphasizing the link between malaria and eBL.


Assuntos
Linfoma de Burkitt , Malária Falciparum , Malária , Humanos , Linfoma de Burkitt/epidemiologia , Linfoma de Burkitt/genética , Plasmodium falciparum , Estudos de Casos e Controles , Uganda/epidemiologia , Quênia/epidemiologia , Tanzânia/epidemiologia , Estudos Transversais , Malária Falciparum/complicações , Malária Falciparum/epidemiologia , Malária Falciparum/parasitologia , Malária/epidemiologia
10.
Glob Health Action ; 16(1): 2159126, 2023 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-36607333

RESUMO

BACKGROUND: Cardiovascular disease (CVD) risk factors are increasing in many sub-Saharan African countries and disproportionately affecting communities in urban slums. Despite this, the contextual factors that influence CVD risk among slum communities have not been fully documented to guide interventions to prevent and control the disease. OBJECTIVE: This study explored the drivers of CVD risk factors in slums in Kampala, Uganda. METHODS: This qualitative study employed focus group discussions (FGDs) to collect data among slum residents. A total of 10 FGDs separate for gender and age group were held in community public places. Discussions were audio-recorded, transcribed, and transcripts analysed thematically with the aid of Atlas ti 7.0. Study themes and sub-themes are presented supported by participant quotations. RESULTS: Five themes highlighted the drivers of CVD risk factors in slum communities. (1) Poverty: a critical underlying factor which impacted access and choice of food, work, and housing. (2) Poverty-induced stress: a key intermediate factor that led to precarious living with smoking and alcohol use as coping measures. (3) The social environment which included socialisation through drinking and smoking, and family and peers modelling behaviours. (4) The physical environment such as the high availability of affordable alcohol and access to amenities for physical activity and healthy foods. (5) Knowledge and information about CVD risk factors which included understanding of a healthy diet and the dangers of smoking and alcohol consumption. CONCLUSION: To address CVD risk in slums, broad-ranging multisectoral interventions are required, including economic empowerment of the slum population, stress reduction and coping interventions, and alcohol legislation. Also, there is a need for community CVD sensitisation and screening as well as increasing access to physical activity amenities and healthy foods within slums.


Assuntos
Doenças Cardiovasculares , Áreas de Pobreza , Humanos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Uganda/epidemiologia , População Urbana , Fatores de Risco de Doenças Cardíacas , Fatores de Risco
11.
BMC Health Serv Res ; 23(1): 22, 2023 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-36627623

RESUMO

BACKGROUND: Nearly 60% of maternal and 45% of newborn deaths occur within 24 h after delivery. Immediate postpartum monitoring could avert death from preventable causes including postpartum hemorrhage, and eclampsia among mothers, and birth asphyxia, hypothermia, and sepsis for babies. We aimed at assessing facility readiness for the provision of postpartum care within the immediate postpartum period. METHODS: A cross-sectional study involving 40 health facilities within the greater Mpigi region, Uganda, was done. An adapted health facility assessment tool was employed in data collection. Data were double-entered into Epi Data version 4.2 and analyzed using STATA version 13 and presented using descriptive statistics. RESULTS: Facility readiness for the provision of postpartum care was low (median score 24% (IQR: 18.7, 26.7). Availability, and use of up-to-date, policies, guidelines and written clinical protocols for identifying, monitoring, and managing postpartum care were inconsistent across all levels of care. Lack of or non-functional equipment poses challenges for screening, diagnosing, and treating postnatal emergencies. Frequent stock-outs of essential drugs and supplies, particularly, hydralazine, antibiotics, oxygen, and blood products for transfusions were more common at health centers compared to hospitals. Inadequate human resources and sub-optimal supplies inhibit the proper functioning of health facilities and impact the quality of postpartum care. Overall, private not-for-profit health facilities had higher facility readiness scores. CONCLUSIONS: Our findings suggest sub-optimal rural health facility readiness to assess, monitor, and manage postpartum emergencies to reduce the risk of preventable maternal/newborn morbidity and mortality. Strengthening health system inputs and supply side factors could improve facility capacity to provide quality postpartum care.


Assuntos
Emergências , Cuidado Pós-Natal , Gravidez , Recém-Nascido , Feminino , Humanos , Uganda/epidemiologia , Estudos Transversais , Instalações de Saúde
12.
Nutr J ; 22(1): 4, 2023 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-36631774

RESUMO

BACKGROUND: This study assessed staple food price volatility, household food consumption scores (FCS), poor household food consumption status and its association with socio-economic inequalities during enforcing and partial lifting of coronavirus disease-2019 (COVID-19) lockdown restrictions in slum and non-slum households (HHs) of Nansana municipality, Uganda. METHODS: Repeated cross-sectional surveys were conducted during enforcing and partial lifting of COVID-19 lockdown restrictions. A total of 205 slum and 200 non-slum HHs were selected for the study. Telephone based interviews with HH heads were used to collect data on socio-economic factors. Data for FCS was collected using the World Food Programme FCS method. Prices for staple foods were collected by face-to-face interviews with food vendors from the local market. Mean staple food price differences before COVID-19 lockdown, during enforcing, and partial lifting of lockdown was tested by Analysis of variance with repeated measures. Multivariate logistic regression analysis was used to assess the association between socio-economic variables and poor food consumption status. A statistical test was considered significant at p < 0.05. RESULTS: Mean staple food prices were significantly higher during enforcing COVID-19 total lockdown restrictions compared to either 1 week before lockdown or partial lifting of lockdown (p < 0.05). Mean FCS for staple cereals and legumes were significantly higher in slum HHs during COVID-19 lockdown compared to when the lockdown was partially lifted (p < 0.05). In slum HHs, the prevalence of poor food consumption status was significantly higher during partial lifting (55.1%) compared to total lockdown of COVID-19 (15.1%), p < 0.05. Among slum HHs during lockdown restrictions, food aid distribution was negatively associated with poor food consumption status (AOR: 0.4, 95% CI: 0.1-0.6), whilst being a daily wage earner was positively associated with poor food consumption status (AOR: 0.5, 95% CI: 0.1-0.6). During partial lifting of COVID-19 lockdown in slum HHs, poor food consumption status was positively associated with female headed HHs (AOR: 1.2, 95%CI: 1.1-1.6), daily wage earners (AOR: 3.2, 95% CI: 2.6-3.8), unemployment (AOR: 1.9, 95% CI: 1.5-2.1) and tenants (AOR: 2.4, 95% CI: 1.8-3.5). Female headed HHs, daily wage earners and tenants were positively associated with poor food consumption status either during enforcing or partial lifting of COVID-19 lockdown restrictions in non-slum HHs. CONCLUSION: Staple food prices increased during enforcing either the COVID-19 lockdown or partial lifting of the lockdown compared to before the lockdown. During the lockdown, food consumption improved in slum HHs that received food aid compared to those slum HHs that did not receive it. Household heads who were females, daily wage earners, unemployed, and tenants were at risk of poor food consumption status either in slum or non-slum, and therefore needed some form of food assistance either during enforcing or partial lifting of the lockdown.


Assuntos
COVID-19 , Coronavirus , Humanos , Feminino , Masculino , Uganda/epidemiologia , Estudos Transversais , COVID-19/epidemiologia , População Urbana , Controle de Doenças Transmissíveis , Áreas de Pobreza
13.
PLoS One ; 18(1): e0279407, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36608035

RESUMO

BACKGROUND: Occupational noise is a common cause of hearing loss in low-income countries. Unfortunately, screening for hearing loss is rarely done due to technical and logistical challenges associated with pure tone audiometry. Wulira app is a valid and potentially cost-effective alternative to pure tone audiometry in screening for occupational hearing loss. We aimed to determine the prevalence of occupational hearing loss among workers in a metal industry company in Kampala district. METHODOLOGY: We recruited 354 participants conveniently from a steel and iron manufacturing industry in Kampala. All eligible participants answered a pretested and validated questionnaire and were assessed for noise induced hearing loss in a quiet office room approximately 500 meters from the heavy machinery area using the Wulira app. Descriptive statistics such as proportions were used to describe the study population while inferential statistics were used to determine associations. RESULTS: Of the 354 participants sampled, 333 (94.1%) were male, and the median age was 27, IQR (25-30). Regarding the risk factors of hearing loss, fourteen (3.9%) had history of smoking and more than half (65.5%) had worked in the industry for more than 2 years. The overall prevalence of hearing loss among industrial workers was 11.3% (40/354). 16.2% and 9% had mild hearing loss in the right and left ear respectively. Bilateral audiometric notch was present where fourteen (4%) of the participants had notch in their right ear while seven (2%) had notch in their left ear. Residing outside Kampala district was associated with hearing loss (OR, 95% CI, 0.213 (0.063-0.725), p = 0.013). CONCLUSION: One in 10 workers in a metal manufacturing industry in Kampala had occupational hearing loss. Industrial workers residing outside Kampala were likely to develop hearing loss. Periodic screening should be done for early detection and intervention to prevent progression of hearing loss in this population.


Assuntos
Surdez , Perda Auditiva Provocada por Ruído , Aplicativos Móveis , Ruído Ocupacional , Doenças Profissionais , Exposição Ocupacional , Humanos , Masculino , Adulto , Feminino , Perda Auditiva Provocada por Ruído/diagnóstico , Perda Auditiva Provocada por Ruído/epidemiologia , Perda Auditiva Provocada por Ruído/etiologia , Estudos Transversais , Uganda/epidemiologia , Audiometria , Audiometria de Tons Puros , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Ruído Ocupacional/efeitos adversos , Exposição Ocupacional/efeitos adversos
14.
Parasit Vectors ; 16(1): 7, 2023 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-36611216

RESUMO

BACKGROUND: Crimean-Congo haemorrhagic fever (CCHF) is a tick-borne viral infection, characterized by haemorrhagic fever in humans and transient asymptomatic infection in animals. It is an emerging human health threat causing sporadic outbreaks in Uganda. We conducted a detailed outbreak investigation in the animal population following the death from CCHF of a 42-year-old male cattle trader in Lyantonde district, Uganda. This was to ascertain the extent of CCHF virus (CCHFV) circulation among cattle and goats and to identify affected farms and ongoing increased environmental risk for future human infections. METHODS: We collected blood and tick samples from 117 cattle and 93 goats, and tested these for anti-CCHFV antibodies and antigen using an enzyme-linked immunosorbent assay (ELISA), quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) and target enrichment next generation sequencing. RESULTS: CCHFV-specific IgG antibodies were detected in 110/117 (94.0%) cattle and 83/93 (89.3%) goats. Animal seropositivity was independently associated with female animals (AOR = 9.42, P = 0.002), and animals reared under a pastoral animal production system (AOR = 6.02, P = 0.019] were more likely to be seropositive than tethered or communally grazed animals. CCHFV was detected by sequencing in Rhipicephalus appendiculatus ticks but not in domestic animals. CONCLUSION: This investigation demonstrated very high seroprevalence of CCHFV antibodies in both cattle and goats in farms associated with a human case of CCHF in Lyantonde. Therefore, building surveillance programs for CCHF around farms in this area and the Ugandan cattle corridor is indicated, in order to identify opportunities for case prevention and control.


Assuntos
Vírus da Febre Hemorrágica da Crimeia-Congo , Febre Hemorrágica da Crimeia , Rhipicephalus , Doenças Transmitidas por Carrapatos , Masculino , Humanos , Animais , Feminino , Bovinos , Adulto , Febre Hemorrágica da Crimeia/epidemiologia , Febre Hemorrágica da Crimeia/veterinária , Gado , Uganda/epidemiologia , Prevalência , Estudos Soroepidemiológicos , Vírus da Febre Hemorrágica da Crimeia-Congo/genética , Cabras , Anticorpos Antivirais
15.
PLoS One ; 18(1): e0279479, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36638086

RESUMO

BACKGROUND: Uganda's efforts to end the HIV epidemic by 2030 are threatened by the increasing number of PLHIV with low-level viraemia (LLV). We conducted a study to determine the prevalence of LLV and the association between LLV and subsequent viral non-suppression from 2016 to 2020 among PLHIV on ART in Uganda. METHOD: This was a retrospective cohort study, using the national viral load (VL) program data from 2016 to 2020. LLV was defined as a VL result of at least 50 copies/ml, but less than 1,000 copies/ml. Multivariable logistic regression was used to determine the factors associated with LLV, and cox proportional hazards regression model was used to determine the association between LLV and viral non-suppression. RESULTS: A cohort of 17,783 PLHIV, of which 1,466 PLHIV (8.2%) had LLV and 16,317 (91.8%) had a non-detectable VL was retrospectively followed from 2016 to 2020. There were increasing numbers of PLHIV with LLV from 2.0% in 2016 to 8.6% in 2020; and LLV was associated with male sex, second line ART regimen and being of lower age. 32.5% of the PLHIV with LLV (476 out of 1,466 PLHIV) became non-suppressed, as compared to 7.7% of the PLHIV (1,254 out of 16,317 PLHIV) with a non-detectable viral load who became non-suppressed during the follow-up period. PLHIV with LLV had 4.1 times the hazard rate of developing viral non-suppression, as compared to PLHIV with a non-detectable VL (adjusted hazard ratio was 4.1, 95% CI: 3.7 to 4.7, p < 0.001). CONCLUSION: Our study indicated that PLHIV with LLV increased from 2.0% in 2016 to 8.6% in 2020, and PLHIV with LLV had 4.1 times the hazard rate of developing viral non-suppression, as compared to PLHIV with a non-detectable VL. Hence the need to review the VL testing algorithm and also manage LLV in Uganda.


Assuntos
Síndrome de Imunodeficiência Adquirida , Fármacos Anti-HIV , Infecções por HIV , HIV-1 , Humanos , Masculino , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Estudos Retrospectivos , Fármacos Anti-HIV/uso terapêutico , Viremia/tratamento farmacológico , Viremia/epidemiologia , Uganda/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Carga Viral
16.
BMC Psychol ; 11(1): 11, 2023 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-36639808

RESUMO

BACKGROUND: Adverse childhood experiences (ACEs) among university students have been linked to a variety of factors and have been shown to have a dose-response relationship with adult health and behavior. OBJECTIVE: To investigate the effect of exposure to ACEs on academic performance, depression, and suicidal ideations among university students. METHODS: A cross-sectional survey among university students at a public university in southwestern Uganda was conducted in 2021, integrating the Adverse Childhood Experiences International Questionnaire for assessing ACEs, the Patient Health Questionnaire for assessing depression symptoms and suicidal ideations, and questions assessing the family structure and academic performance as adopted from similar studies. Regression analysis was performed, and 3 models were generated to answer the study hypotheses. RESULTS: A total of 653 undergraduate university students with a mean age of 22.80 (± 3.16) years were recruited. Almost all students (99.8%) experienced one or more ACEs, with physical abuse being the common ACE reported. The average depression symptom severity was statistically higher among individuals who experienced any form of ACEs. No relationship was observed between the ACEs experienced and self-rated academic performance. Similarly, on regression analysis, the cumulative number of ACEs was not associated with self-rated academic performance (ß = - 0.007; 95% CI - 0.031 to 0.016; p = 0.558). However, the cumulative number of ACEs was positively associated with depression symptom severity (ß = 0.684; 95% CI 0.531-0.837; p < 0.001), as well as increased the likelihood of suicidal ideations (aOR = 1.264; 95% CI 01.090-1.465; p < 0.001). CONCLUSIONS: The burden of ACEs is exceedingly high among Ugandan university students, highlighting the urgency in strengthening effective child protection strategies to protect Uganda's rapidly growing population from mental ill-health and avoid future psychological disability, a burden to the healthcare system. The study's findings will also be useful to practitioners/policymakers working to prevent/limit child maltreatment globally.


Assuntos
Desempenho Acadêmico , Experiências Adversas da Infância , Adulto , Criança , Humanos , Adulto Jovem , Ideação Suicida , Depressão/epidemiologia , Depressão/psicologia , Uganda/epidemiologia , Universidades , Estudos Transversais , Estudantes/psicologia
17.
BMC Health Serv Res ; 23(1): 40, 2023 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-36647104

RESUMO

BACKGROUND: Uganda's current guidelines recommend immediate initiation of Anti-Retroviral Therapy (ART) for persons living with HIV in order to reduce HIV/AIDS related morbidity and mortality. However, not all eligible PLHIV initiate ART within the recommended time following HIV diagnosis. We assessed the prevalence and factors associated with delayed ART initiation among PLHIV referred for ART initiation, five years since rolling out the test and treat guidelines. METHODS: In this cross-sectional study, we enrolled adult patients referred to Mulago Immune Suppressive Syndrome (Mulago ISS) clinic for ART initiation from January 2017 to May 2021. We collected data on socio-demographics, HIV diagnosis and referral circumstances, and time to ART initiation using a questionnaire. The outcome of interest was proportion of patients that delayed ART, defined as spending more than 30 days from HIV diagnosis to ART initiation. We performed multivariable logistic regression and identified significant factors. RESULTS: A total of 312 patients were enrolled of which 62.2% were female. The median (inter-quartile range [IQR]) age and baseline CD4 count of the patients were 35 (28-42) years and 315 (118.8-580.5) cells/µL respectively. Forty-eight (15.4%) patients delayed ART initiation and had a median (IQR) time to ART of 92 (49.0-273.5) days. The factors associated with delayed ART initiation were; 1) having had the HIV diagnosis made from a private health facility versus public, (adjusted odds ratio [aOR] = 2.4 (95% confidence interval [CI] 1.1-5.5); 2) initial denial of positive HIV test results, aOR = 5.4 (95% CI: 2.0-15.0); and, 3) having not received a follow up phone call from the place of HIV diagnosis, aOR = 2.8 (95% CI: 1.2-6.8). CONCLUSION: There was significant delay of ART initiation among referred PLHIV within 5 years after the rollout of test and treat guidelines in Uganda. Health system challenges in the continuity of HIV care services negatively affects timely ART initiation among referred PLHIV in Uganda.


Assuntos
Síndrome de Imunodeficiência Adquirida , Fármacos Anti-HIV , Infecções por HIV , Humanos , Adulto , Feminino , Masculino , Estudos Transversais , Uganda/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Terapia Antirretroviral de Alta Atividade , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Contagem de Linfócito CD4 , Fármacos Anti-HIV/uso terapêutico
18.
PLoS One ; 18(1): e0280138, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36634037

RESUMO

BACKGROUND: The HIV burden remains a critical public health concern and women engaged in sex work [WESW] are at significantly higher risk compared to the general adult population. Similar to other sub-Saharan African countries, Uganda reports high rates of HIV prevalence among WESW. Yet, they have not been targeted by theory-informed HIV prevention intervention approaches. METHODS: We conducted semi-structured in-depth interviews with 20 WESW upon intervention completion to explore their experiences with an evidence-based HIV risk reduction intervention that was implemented as part of a combination intervention tested in a clinical trial in Uganda (2018-2023. Specifically, we explored their initial motivations and concerns for participating in the intervention, barriers and facilitators to attendance, and their feedback on specific intervention characteristics. RESULTS: The main expectations revolved around access to health-related information, including information on STIs, HIV, and PrEP as well as on how one can protect themselves while engaging in sex work. Initial concerns were around potential breach of confidentiality and fear of arrest. The main facilitators for session attendance were the motivation to learn health-related information, the attitude of facilitators, and the incentives received for participation, whereas main challenges were related to family commitments and work schedules. WESW appreciated the group format of the intervention and found the location and times of the intervention delivery acceptable. DISCUSSION AND CONCLUSIONS: Overall, our findings suggest that the HIV risk reduction intervention was appropriate and acceptable to WESW. Yet, WESW experience unique concerns and barriers that need to be accounted for when designing interventions targeting this population, especially in resource-limited settings where sex work is illegal and highly stigmatized. CLINICAL TRIAL REGISTRATION: NCT03583541.


Assuntos
Infecções por HIV , Trabalho Sexual , Adulto , Feminino , Humanos , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/tratamento farmacológico , Pesquisa Qualitativa , Comportamento de Redução do Risco , Uganda/epidemiologia
19.
Emerg Infect Dis ; 29(1): 224-226, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36529453

RESUMO

We describe a cluster of COVID-19 breakthrough infections after vaccination in Kyamulibwa, Kalungu District, Uganda. All but 1 infection were from SARS-CoV-2 Omicron strain BA.5.2.1. We identified 6 distinct genotypes by genome sequencing. Infections were mild, suggesting vaccination is not protective against infection but may limit disease severity.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , SARS-CoV-2/genética , Uganda/epidemiologia
20.
AIDS ; 37(1): 51-59, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36083142

RESUMO

OBJECTIVE: Improved understanding of the effect of HIV infection on Kaposi sarcoma (KS) presentation and outcomes will guide development of more effective KS staging and therapeutic approaches. We enrolled a prospective cohort of epidemic (HIV-positive; HIV + KS) and endemic (HIV-negative; HIV - KS) KS patients in Uganda to identify factors associated with survival and response. METHODS: Adults with newly diagnosed KS presenting for care at the Uganda Cancer Institute (UCI) in Kampala, Uganda, between October 2012 and December 2019 were evaluated. Participants received chemotherapy per standard guidelines and were followed over 1 year to assess overall survival (OS) and treatment response. RESULTS: Two hundred participants were enrolled; 166 (83%) had HIV + KS, and 176 (88%) were poor-risk tumor (T1) stage. One-year OS was 64% (95% confidence interval [CI] 57-71%), with the hazard of death nearly threefold higher for HIV + KS (hazard ratio [HR] = 2.93; P  = 0.023). Among HIV + KS, abnormal chest X-ray (HR = 2.81; P  = 0.007), lower CD4 + T-cell count (HR = 0.68 per 100 cells/µl; P  = 0.027), higher HIV viral load (HR = 2.22 per log 10  copies/ml; P  = 0.026), and higher plasma Kaposi sarcoma-associated herpesvirus (KSHV) copy number (HR = 1.79 per log 10  copies/ml; P  = 0.028) were associated with increased mortality. Among HIV - KS, factors associated with mortality included Karnofsky score <70 (HR = 9.17; P  = 0.045), abnormal chest X-ray (HR = 8.41; P  = 0.025), and higher plasma KSHV copy number (HR = 6.21 per log 10  copies/ml; P  < 0.001). CONCLUSIONS: Although survival rates were better for HIV - KS than HIV + KS, the high mortality rate seen in both groups underscores the urgent need to identify new staging and therapeutic approaches. Factors associated with mortality, including high plasma KSHV, may serve as important targets of therapy.


Assuntos
Infecções por HIV , Sarcoma de Kaposi , Humanos , Sarcoma de Kaposi/complicações , Sarcoma de Kaposi/tratamento farmacológico , Estudos Prospectivos , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Uganda/epidemiologia
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