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1.
Pan Afr Med J ; 35(Suppl 2): 140, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193955

RESUMO

The COVID-19 pandemic and its public health control measures have led to worldwide interruptions in healthcare service delivery, and cancer services are no exception. These interruptions have exacerbated the effects of previously reported barriers to accessing cancer care which was reportedly low even before the pandemic. If these effects are not mitigated, the achievements in cancer control that had already been made could be watered down. Measuring the impact of COVID-19 pandemic control measures on delivery of and access to cancer services in Uganda as well as other countries worldwide can inform the design of current and future responses to epidemics while putting into context other diseases like cancer that have a high burden.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Acesso aos Serviços de Saúde , Neoplasias/terapia , Pandemias , Pneumonia Viral/epidemiologia , Continuidade da Assistência ao Paciente , Assistência à Saúde , Países em Desenvolvimento , Promoção da Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Programas de Rastreamento , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Quarentena , Sistema de Registros , Uganda/epidemiologia
2.
Pan Afr Med J ; 35(Suppl 2): 142, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193957

RESUMO

The COVID-19 pandemic continues to cause uncertainty to Uganda's food security among underprivileged households. The Corona virus Response Team inaugurated a relief food distribution campaign, ensuing from the countrywide COVID-19 lockdown to counter the rising food insecurities in many urban and rural poor households. However, the relief response campaign has received a lot of critics from both rural and urban communities who were planned as the beneficiaries. Three months into the COVID-19 pandemic the population reports; delays in the distribution, poor quality supplies, arrests and continued restrictions, slow paced distribution among household, and a negative impact on the health care system. As a learning from the current experience, we recommend; a multisectoral engagement, better planning, a decentralized food distribution, and formulation of clear food distribution guidelines to guide the future responses. Use of mobile cash transfers to reach out to the food insecure households can support local economies and lower the cost on middlemen and interrelated corruption.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Assistência Alimentar , Abastecimento de Alimentos , Pandemias , Pneumonia Viral/epidemiologia , Características da Família , Assistência Alimentar/economia , Assistência Alimentar/organização & administração , Assistência Alimentar/estatística & dados numéricos , Abastecimento de Alimentos/economia , Abastecimento de Alimentos/estatística & dados numéricos , Humanos , Colaboração Intersetorial , População Rural , Uganda/epidemiologia , Populações Vulneráveis
4.
BMC Infect Dis ; 20(1): 835, 2020 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-33176708

RESUMO

BACKGROUND: The spatial distribution and burden of dengue in sub-Saharan Africa remains highly uncertain, despite high levels of ecological suitability. The goal of this study was to describe the epidemiology of dengue among a cohort of febrile children presenting to outpatient facilities located in areas of western Uganda with differing levels of urbanicity and malaria transmission intensity. METHODS: Eligible children were first screened for malaria using rapid diagnostic tests. Children with a negative malaria result were tested for dengue using a combination NS1/IgM/IgG rapid test (SD Bioline Dengue Duo). Confirmatory testing by RT-PCR was performed in a subset of participants. Antigen-capture ELISA was performed to estimate seroprevalence. RESULTS: Only 6 of 1416 (0.42%) children had a positive dengue rapid test, while none of the RT-PCR results were positive. ELISA testing demonstrated reactive IgG antibodies in 28 (2.2%) participants with the highest prevalence seen at the urban site in Mbarara (19 of 392, 4.9%, p < 0.001). CONCLUSIONS: Overall, these findings suggest that dengue, while present, is an uncommon cause of non-malarial, pediatric febrile illness in western Uganda. Further investigation into the eocological factors that sustain low-level transmission in urban settings are urgently needed to reduce the risk of epidemics.


Assuntos
Vírus da Dengue/genética , Vírus da Dengue/imunologia , Dengue/diagnóstico , Dengue/epidemiologia , Febre/diagnóstico , Adolescente , Criança , Pré-Escolar , Dengue/virologia , Testes Diagnósticos de Rotina/efeitos adversos , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Malária/diagnóstico , Malária/epidemiologia , Malária/parasitologia , Masculino , Plasmodium/imunologia , Plasmodium/isolamento & purificação , Prevalência , Estudos Prospectivos , Reação em Cadeia da Polimerase em Tempo Real , Estudos Soroepidemiológicos , Uganda/epidemiologia
5.
PLoS One ; 15(10): e0236458, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33125383

RESUMO

BACKGROUND: Prostate cancer is the second most common cancer among men in Uganda, with over 2086 incident cases in 2018. This study's objective was to report the clinical characteristics and primary management of men diagnosed with prostate cancer at the Uganda Cancer Institute from 1st January 2015 to 31st December 2019. METHODS: Records from all men diagnosed with Prostate cancer at the Uganda Cancer Institute from 1st January 2015 to 31st December 2019 were reviewed. Clinical characteristics and primary treatment were recorded. Risk categorization was done using the European Society for Medical Oncology prostate cancer risk group classification. RESULTS: A total of 874 medical records for men diagnosed with prostate cancer was retrieved. The median age was 70 years (interquartile range 64-77). In this study, 501 (57.32%) patients had localized disease. Among patients with localized disease, 2 (0.23%) were classified as low-risk, 5 (0.53%) as intermediate-risk, and 494 (56.52%) as high-risk. Three hundred seventy-three (373) patients had metastatic disease at diagnosis. Among patients with distant metastases, the most common site of metastases was bone 143 (16.36%), followed by spinal cord 54 (6.18%), abdomen 22 (2.52%), and lungs 14 (1.60%). Regarding the primary treatment options majority of the patients were on chemotherapy 384(43.94%) followed by hormonal therapy 336 (38.44%) and radiotherapy 127 (14.53%). CONCLUSION: The majority of the patients diagnosed with prostate cancer at the Uganda Cancer Institute presented with advanced disease. The primary treatments were mostly chemotherapy, hormonal therapy, and radiotherapy. There is a need to improve prostate cancer screening in regional health care facilities and the communities to enhance early detection and management of prostate cancer.


Assuntos
Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/terapia , Idoso , Idoso de 80 Anos ou mais , Detecção Precoce de Câncer , Acesso aos Serviços de Saúde , Humanos , Calicreínas/sangue , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/epidemiologia , Uganda/epidemiologia
6.
Can J Surg ; 63(5): E418-E421, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33009901

RESUMO

SUMMARY: The Canadian Network for International Surgery (CNIS) hosted a workshop in May of 2020 with a goal of critically evaluating Trauma Team Training courses. The workshop was held virtually because of the coronavirus disease 2019 (COVID-19) pandemic. Twenty-three participants attended from 8 countries: Canada, Guyana, Kenya, Nigeria, Switzerland, Tanzania, Uganda and the United States. More participants were able to attend the virtual meeting than the traditional in-person meetings. Web-based videoconference software was used, participants presented prerecorded PowerPoint videos, and questions were raised using a written chat. The review proved successful, with discussions and recommendations for improvements surrounding course quality, lecture content, skills sessions, curriculum variations and clinical practical scenarios. The CNIS's successful experience conducting an online curriculum review involving international participants may prove useful to others proceeding with collaborative projects during the COVID-19 pandemic.


Assuntos
Congressos como Assunto/organização & administração , Infecções por Coronavirus/prevenção & controle , Currículo , Cirurgia Geral/educação , Cooperação Internacional , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus/patogenicidade , Canadá/epidemiologia , Congressos como Assunto/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Cirurgia Geral/métodos , Guiana/epidemiologia , Humanos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Quênia/epidemiologia , Nigéria/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Suíça/epidemiologia , Tanzânia/epidemiologia , Uganda/epidemiologia , Estados Unidos/epidemiologia , Comunicação por Videoconferência/organização & administração , Comunicação por Videoconferência/normas , Ferimentos e Lesões/cirurgia
8.
BMC Public Health ; 20(1): 1561, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33066745

RESUMO

BACKGROUND: With many medical equipment in hospitals coming in direct contact with healthcare workers, patients, technicians, cleaners and sometimes care givers, it is important to pay close attention to their capacity in harboring potentially harmful pathogens. The goal of this study was to assess the role that medical equipment may potentially play in hospital acquired infections in four public health facilities in Uganda. METHODS: A cross-sectional study was conducted from December 2017 to January 2018 in four public health facilities in Uganda. Each piece of equipment from the neonatal department, imaging department or operating theatre were swabbed at three distinct points: a location in contact with the patient, a location in contact with the user, and a remote location unlikely to be contacted by either the patient or the user. The swabs were analyzed for bacterial growth using standard microbiological methods. Seventeen bacterial isolates were randomly selected and tested for susceptibility/resistance to common antibiotics. The data collected analyzed in STATA version 14. RESULTS: A total of 192 locations on 65 equipment were swabbed, with 60.4% of these locations testing positive (116/192). Nearly nine of ten equipment (57/65) tested positive for contamination in at least one location, and two out of three equipment (67.7%) tested positive in two or more locations. Of the 116 contaminated locations 52.6% were positive for Bacillus Species, 14.7% were positive for coagulase negative staphylococcus, 12.9% (15/116) were positive for E. coli, while all other bacterial species had a pooled prevalence of 19.8%. Interestingly, 55% of the remote locations were contaminated compared to 66% of the user contacted locations and 60% of the patient contacted locations. Further, 5/17 samples were resistant to at least three of the classes of antibiotics tested including penicillin, glycylcycline, tetracycline, trimethoprim sulfamethoxazole and urinary anti-infectives. CONCLUSION: These results provides strong support for strengthening overall disinfection/sterilization practices around medical equipment use in public health facilities in Uganda. There's also need for further research to make a direct link to the bacterial isolates identified and cases of infections recorded among patients in similar settings.


Assuntos
Infecção Hospitalar/epidemiologia , Contaminação de Equipamentos/estatística & dados numéricos , Equipamentos e Provisões/microbiologia , Hospitais Públicos , Centros de Atenção Terciária , Estudos Transversais , Humanos , Uganda/epidemiologia
9.
BMC Infect Dis ; 20(1): 727, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023498

RESUMO

BACKGROUND: Viral load (VL) testing is the gold-standard approach for monitoring human immunodeficiency virus (HIV) treatment success and virologic failure, but uptake is suboptimal in resource-limited and rural settings. We conducted a cross-sectional study of risk factors for non-uptake of VL testing in rural Uganda. METHODS: We conducted a cross-sectional analysis of uptake of VL testing among randomly selected people with HIV (PWH) receiving anti-retroviral treatment (ART) for at least 6 months at all eight primary health centers in Gomba district, rural Uganda. Socio-demographic and clinical data were extracted from medical records for the period January to December 2017. VL testing was routinely performed 6 months after ART initiation and 12 months thereafter for PWH stable on ART. We used descriptive statistics and multivariable logistic regression to evaluate factors associated with non-uptake of VL testing (the primary outcome). RESULTS: Of 414 PWH, 60% were female, and the median age was 40 years (interquartile range [IQR] 31-48). Most (62.3%) had been on ART > 2 years, and the median duration of treatment was 34 months (IQR 14-55). Thirty three percent did not receive VL testing: 36% of women and 30% of men. Shorter duration of ART (≤2 years) (adjusted odds ratio [AOR] 2.38; 95% CI:1.37-4.12; p = 0.002), younger age 16-30 years (AOR 2.74; 95% CI:1.44-5.24; p = 0.002) and 31-45 years (AOR 1.92; 95% CI 1.12-3.27; p = 0.017), and receipt of ART at Health Center IV (AOR 2.85; 95% CI: 1.78-4.56; p < 0.001) were significantly associated with non-uptake of VL testing. CONCLUSIONS: One-in-three PWH on ART missed VL testing in rural Uganda. Strategies to improve coverage of VL testing, such as VL focal persons to flag missed tests, patient education and demand creation for VL testing are needed, particularly for recent ART initiates and younger persons on treatment, in order to attain the third Joint United Nations Program on HIV/AIDS (UNAIDS) 95-95-95 target - virologic suppression for 95% of PWH on ART.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , HIV-1/imunologia , População Rural , Carga Viral/efeitos dos fármacos , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Infecções por HIV/virologia , Humanos , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Testes Sorológicos , Resposta Viral Sustentada , Uganda/epidemiologia , Adulto Jovem
10.
Afr J AIDS Res ; 19(3): 249-262, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33119459

RESUMO

Reducing multiple and concurrent partnerships has been identified as a priority in generalised HIV epidemics, yet developing successful interventions to bring about such behaviour change has proven challenging. We offered a three-session intervention aimed to improve couple relationship quality and address HIV risk factors, particularly concurrent sexual partnerships (CSP), in a peri-urban community of Kampala, Uganda. Before launching the intervention, a different group of community members participated in eight single-gender focus group discussions (FGDs) which explored issues of couple relationship quality and satisfaction. Findings from the FGDs guided the intervention. All 162 couples invited to the intervention completed a survey pre- and post-intervention. In FGDs, women and men discussed challenges faced in their relationships, including pervasive dissatisfaction, financial constraints, deception and lack of trust, poor communication, lack of sexual satisfaction, and concurrent sexual partnerships. A difference-in-difference analysis showed no measurable impact of the intervention on relationship quality or sexual risk behaviours over a six-month follow-up among 183 individuals who participated in the intervention, although many stated in response to open-ended questions that they had experienced positive relationship changes. Qualitative findings suggest high demand for couple-focused interventions but also reveal many individual-, couple-, community- and structural-level factors which contribute to women and men seeking concurrent sexual partnerships. More intensive interventions may be needed to overcome these barriers to behaviour change and reduce HIV risk. These findings also raise questions about how to interpret divergent qualitative and quantitative data, a topic which has received little attention in the literature.


Assuntos
Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Relações Interpessoais , Parceiros Sexuais , Adulto , Feminino , Grupos Focais , Infecções por HIV/epidemiologia , Humanos , Masculino , Fatores de Risco , Comportamento Sexual/fisiologia , Parceiros Sexuais/psicologia , População Suburbana , Uganda/epidemiologia
11.
PLoS One ; 15(9): e0239543, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986767

RESUMO

HIV prevalence is estimated to be 2.7% in South Sudan; however, little is known about the young country's epidemic. We conducted a respondent-driven sampling biobehavioral survey in Juba of female sex workers (FSW) aged ≥15 years who sold or exchanged sex in the last 6 months to learn more about this population. We enrolled 838 FSW from November 2015 to March 2016 and estimated HIV prevalence to be 37.8%. Prevalence of active syphilis was 7.3%. FSW were from South Sudan and most neighboring countries. Comprehensive knowledge of HIV was 11.1% and 64.2% of FSW had never spoken with an outreach worker. In multivariable analysis, HIV was associated with being from Uganda (aOR: 3.3, 95% CI: 1.7-6.1) or Kenya (aOR: 4.3, 95% CI: 1.5-13.0) versus from South Sudan. Our survey suggests that FSW may play a critical role in South Sudan's HIV epidemic and highlights the importance of tailoring services to the unique needs of FSW of all nationalities in Juba.


Assuntos
Infecções por HIV/epidemiologia , Profissionais do Sexo/estatística & dados numéricos , Sífilis/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Quênia/epidemiologia , Prevalência , Sudão do Sul/epidemiologia , Inquéritos e Questionários , Uganda/epidemiologia , Adulto Jovem
12.
PLoS One ; 15(9): e0239599, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986741

RESUMO

The harvest of bushmeat is widespread in the tropics and sub-tropics. Often in these communities, there is a dependence on bushmeat for both food security and basic income. Despite the importance of bushmeat for households worldwide, the practice raises concern for transmission of zoonotic pathogens through hunting, food preparation, and consumption. In Uganda, harvest of wildlife is illegal, but bushmeat hunting, is commonplace. We interviewed 292 women who cook for their households and 180 self-identified hunters from 21 villages bordering Murchison Falls National Park in Uganda to gain insights into bushmeat preferences, opportunity for zoonotic pathogen transmission, and awareness of common wildlife-associated zoonoses. Both hunters and women who cook considered primates to be the most likely wildlife species to carry diseases humans can catch. Among common zoonotic pathogens, the greatest proportions of women who cook and hunters believed that pathogens causing stomach ache or diarrhea and monkeypox can be transmitted by wildlife. Neither women who cook nor hunters report being frequently injury during cooking, butchering, or hunting, and few report taking precautions while handling bushmeat. The majority of women who cook believe that hunters and dealers never or rarely disguise primate meat as another kind of meat in market, while the majority of hunters report that they usually disguise primate meat as another kind of meat. These data play a crucial role in our understanding of potential for exposure to and infection with zoonotic pathogens in the bushmeat trade. Expanding our knowledge of awareness, perceptions and risks enables us to identify opportunities to mitigate infections and injury risk and promote safe handling practices.


Assuntos
Atitude Frente a Saúde , Conscientização , Doenças Transmitidas por Alimentos/microbiologia , Carne/microbiologia , Zoonoses/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Animais Selvagens , Culinária , Feminino , Abastecimento de Alimentos , Doenças Transmitidas por Alimentos/epidemiologia , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Parques Recreativos , Fatores de Risco , Inquéritos e Questionários , Uganda/epidemiologia , Adulto Jovem , Zoonoses/epidemiologia , Zoonoses/microbiologia , Zoonoses/transmissão
13.
Artigo em Inglês | MEDLINE | ID: mdl-32882804

RESUMO

Sanitation infrastructure are not able to cope with the increasing population in low-income countries, which leaves populations exposed to faecal contamination from multiple pathways. This study evaluated public health risk (using SaniPath) in a low-income community during the dry season, to identify the dominant exposure pathways, and compare this data to existing data for the rainy season, questioning the assumption that risk of faecal contamination is higher in the rainy season. SaniPath was used to collect and assess exposure and environmental data, and to generate risk profiles for each pathway. In the dry season the highest exposure frequency was for bathing and street food, exposure frequency generally increased, and seasonal variation was found in five pathways. The highest hazards in the dry season were through contact with drains, soil, and street food. Seasonal variation was found in the contamination of open drains and street food, with higher levels of Escherichia coli (E. coli) in the dry season. Open drains were identified as the most dominant risk pathway in both seasons, but risk was higher in the dry season. This highlights the complex nature of seasonal variation of faecal risk, and questions the assumption that risk is higher in the rainy season.


Assuntos
Escherichia coli , Fezes , Pobreza , Saneamento , Humanos , Estações do Ano , Uganda/epidemiologia
14.
PLoS One ; 15(9): e0239090, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32956373

RESUMO

In rabies endemic areas, appropriate management of dog bites is critical in human rabies prevention. Victims must immediately wash bite wound for 15 minutes with water, soap, and a disinfectant before seeking medical care. This study investigated the epidemiology of dog bites and the determinants of compliance to these pre-clinical guidelines requirements among dog bite victims from high rabies-burden areas of Wakiso and Kampala, Uganda. An explanatory sequential mixed-methods study design was used. Quantitative data were collected from 376 dog-bite patients at two healthcare facilities. Qualitative data were also collected through 13 in-depth interviews with patients, healthcare workers, herbalists, and veterinarians. Qualitative data were analyzed using a deductive thematic approach. Generalized linear models were used to determine factors associated with compliance. Nearly half (190, 51%) of the patients were from Wakiso District and 293 (77.9%) had grade II wounds. Most of the wounds (171, 45.5%) were on the legs. Two-thirds of the bites occurred in public places. Only 70 (19%) of the bite patients had complied with pre-clinical guidelines. Nearly half of the patients had applied substances that were not recommended e.g. herbs (47/193), antiseptics (46/193), "black stone" (25/193), and unknown creams (10/193). Factors negatively associated with compliance included: being aged 15 years or older, adjPR = 0.70 (0.47-0.92) and knowing the dog owner, adjPR = 0.65 (0.36-0.93). However, attainment of secondary or higher education, adjPR = 1.76 (1.24-3.79), being in employment, adjPR = 1.48 (1.09-2.31), perception that the dog was sick, adjPR = 1.47 (1.02-2.72) and knowledge about the dog's subsequent victim(s) adjPR = 0.35 (0.17-0.70) were positively associated with compliance. High occurrence of dog bites in public places by free-roaming dogs suggests the need for deliberate promotion of responsible dog ownership. Additionally, targeted health education may be required to improve the low compliance to pre-clinical guidelines.


Assuntos
Mordeduras e Picadas/epidemiologia , Mordeduras e Picadas/terapia , Cães , Raiva/prevenção & controle , Adolescente , Adulto , Animais , Mordeduras e Picadas/prevenção & controle , Cães/virologia , Feminino , Humanos , Masculino , Doenças Negligenciadas/prevenção & controle , Vírus da Raiva/isolamento & purificação , Uganda/epidemiologia , Adulto Jovem
15.
PLoS One ; 15(9): e0239087, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32960927

RESUMO

BACKGROUND: Uganda has been making progress towards universal HIV test and treat since 2013 and the 2016 test and treat policy was expanded from the 2013 guidelines. The expanded policy was rolled out in 2017 across the country. The treatment outcomes of this new policy have not yet been assessed at program level. The objective of this study was to determine the treatment outcome of the HIV test and treat policy in TASO Tororo Clinic, Eastern Uganda. METHODOLOGY: This was a retrospective cohort study using secondary data. The study involved 580 clients who were newly diagnosed HIV positive in TASO Tororo clinic between June 2017 and May 2018, who were then followed up for ART initiation, retention in care, viral load monitoring and viral load suppression. The data was analyzed using Stat 14.0 version statistical software application. RESULTS: Of the 580 clients, 93.1%(540) were adults aged ≥20 years. The uptake of test and treat was at 92.4%(536) and 12 months retention was at 78.7% (422). The factors associated with retention in care were a) being counselled before ART initiation, AOR 2.41 (95%CI, 1.56-3.71), b) having a treatment supporter, AOR 1.57 (95%CI, 1.02-2.43) and having an opportunistic infection, AOR 2.99 (95%CI:1.21-7.41). The viral load coverage was 52.4% (221) and viral load suppression rate was 89.1% (197) of clients monitored. Age <20 years was the only identified factor associated with vial load non suppression, AOR 7.35 (95% CI = 2.23-24.24). CONCLUSION: This study found high uptake of ART under test and treat policy, with very low viral load coverage, and a high viral load suppression rate among those monitored. The study therefore highlights a need to differentiate viral load testing based on the population needs and ensure each client testing positive receives pre-ART initiation counselling so as to improve retention in care.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/diagnóstico , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adolescente , Adulto , Criança , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Programas de Rastreamento , Estudos Retrospectivos , Resultado do Tratamento , Uganda/epidemiologia , Carga Viral , Adulto Jovem
16.
BMJ Open Respir Res ; 7(1)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32900781

RESUMO

RATIONALE: Detailed data on the characteristics and outcomes of patients with COVID-19 in sub-Saharan Africa are limited. OBJECTIVE: We determined the clinical characteristics and treatment outcomes of patients diagnosed with COVID-19 in Uganda. MEASUREMENTS: As of the 16 May 2020, a total of 203 cases had been confirmed. We report on the first 56 patients; 29 received hydroxychloroquine (HCQ) and 27 did not. Endpoints included admission to intensive care, mechanical ventilation or death during hospitalisation. MAIN RESULTS: The median age was 34.2 years; 67.9% were male; and 14.6% were <18 years. Up 57.1% of the patients were asymptomatic. The most common symptoms were fever (21.4%), cough (19.6%), rhinorrhea (16.1%), headache (12.5%), muscle ache (7.1%) and fatigue (7.1%). Rates of comorbidities were 10.7% (pre-existing hypertension), 10.7% (diabetes) and 7.1% (HIV), Body Mass Index (BMI) of ≥30 36.6%. 37.0% had a blood pressure (BP) of >130/90 mm Hg, and 27.8% had BP of >140/90 mm Hg. Laboratory derangements were leucopenia (10.6%), lymphopenia (11.1%) and thrombocytopenia (26.3%). Abnormal chest X-ray was observed in 14.3%. No patients reached the primary endpoint. Time to clinical recovery was shorter among patients who received HCQ, but this difference did not reach statistical significance. CONCLUSION: Most of the patients with COVID-19 presented with mild disease and exhibited a clinical trajectory not similar to other countries. Outcomes did not differ by HCQ treatment status in line with other concluded studies on the benefit of using HCQ in the treatment of COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Adulto , Fatores Etários , Índice de Massa Corporal , Estudos de Coortes , Inibidores Enzimáticos/uso terapêutico , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Hidroxicloroquina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Prospectivos , Respiração Artificial/estatística & dados numéricos , Índice de Gravidade de Doença , Fatores Sexuais , Resultado do Tratamento , Uganda/epidemiologia
17.
BMC Med Ethics ; 21(1): 91, 2020 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-32962671

RESUMO

BACKGROUND: In response to COVID-19 pandemic, the Government of Uganda adopted public health measures to contain its spread in the country. Some of the initial measures included refusal to repatriate citizens studying in China, mandatory institutional quarantine, and social distancing. Despite being a public health emergency, the measures adopted deserve critical appraisal using an ethics and human rights approach. The goal of this paper is to formulate an ethics and human rights criteria for evaluating public health measures and use it to reflect on the ethical propriety of those adopted by the government of Uganda to contain the spread of COVID-19. MAIN BODY: We begin by illustrating the value of ethics and human rights considerations for public health measures including during emergencies. We then summarize Uganda's social and economic circumstances and some of the measures adopted to contain the spread of COVID-19. After reviewing some of the ethics and human rights considerations for public health, we reflect upon the ethical propriety of some of Uganda's responses to COVID-19. We use content analysis to identify the measures adopted by the government of Uganda to contain the spread of COVID-19, the ethics and human rights considerations commonly recommended for public health responses and their importance. Our study found that some of the measures adopted violate ethics and human rights principles. We argue that even though some human rights can sometimes be legitimately derogated and limited to meet public health goals during public health emergencies, measures that infringe on human rights should satisfy certain ethics and human rights criteria. Some of these criteria include being effective, strictly necessary, proportionate to the magnitude of the threat, reasonable in the circumstances, equitable, and least restrictive. We reflect on Uganda's initial measures to combat the spread of COVID-19 and argue that many of them fell short of these criteria, and potentially limit their effectiveness. CONCLUSION: The ethical legitimacy of public health measures is valuable in itself and for enhancing effectiveness of the measures. Such legitimacy depends on the extent to which they conform to ethics and human rights principles recommended for public health measures.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Direitos Humanos , Pneumonia Viral/epidemiologia , Saúde Pública/ética , Betacoronavirus , Países em Desenvolvimento , Humanos , Pandemias , Uganda/epidemiologia
18.
PLoS One ; 15(8): e0237656, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32866167

RESUMO

OBJECTIVE: Preterm birth is the primary driver of neonatal mortality worldwide, but it is defined by gestational age (GA) which is challenging to accurately assess in low-resource settings. In a commitment to reducing preterm birth while reinforcing and strengthening facility data sources, the East Africa Preterm Birth Initiative (PTBi-EA) chose eligibility criteria that combined GA and birth weight. This analysis evaluated the quality of the GA data as recorded in maternity registers in PTBi-EA study facilities and the strength of the PTBi-EA eligibility criteria. METHODS: We conducted a retrospective analysis of maternity register data from March-September 2016. GA data from 23 study facilities in Migori, Kenya and the Busoga Region of Uganda were evaluated for completeness (variable present), consistency (recorded versus calculated GA), and plausibility (falling within the 3rd and 97th birth weight percentiles for GA of the INTERGROWTH-21st Newborn Birth Weight Standards). Preterm birth rates were calculated using: 1) recorded GA <37 weeks, 2) recorded GA <37 weeks, excluding implausible GAs, 3) birth weight <2500g, and 4) PTBi-EA eligibility criteria of <2500g and between 2500g and 3000g if the recorded GA is <37 weeks. RESULTS: In both countries, GA was the least recorded variable in the maternity register (77.6%). Recorded and calculated GA (Kenya only) were consistent in 29.5% of births. Implausible GAs accounted for 11.7% of births. The four preterm birth rates were 1) 14.5%, 2) 10.6%, 3) 9.6%, 4) 13.4%. CONCLUSIONS: Maternity register GA data presented quality concerns in PTBi-EA study sites. The PTBi-EA eligibility criteria of <2500g and between 2500g and 3000g if the recorded GA is <37 weeks accommodated these concerns by using both birth weight and GA, balancing issues of accuracy and completeness with practical applicability.


Assuntos
Coleta de Dados/normas , Idade Gestacional , Serviços de Saúde Materna/organização & administração , Nascimento Prematuro/epidemiologia , Sistema de Registros/estatística & dados numéricos , Peso ao Nascer , Coleta de Dados/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Recém-Nascido , Quênia/epidemiologia , Serviços de Saúde Materna/estatística & dados numéricos , Gravidez , Nascimento Prematuro/prevenção & controle , Melhoria de Qualidade , Sistema de Registros/normas , Reprodutibilidade dos Testes , Estudos Retrospectivos , Uganda/epidemiologia
19.
Medicine (Baltimore) ; 99(39): e22352, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991450

RESUMO

BACKGROUND: Antiretroviral therapy for HIV in sub-Saharan Africa has transformed the highly infectious virus to a stable chronic condition, with the advent of Highly active antiretroviral therapy (HAART). The longterm effects of HAART on the oral health of children are understudied. OBJECTIVE: To compare the effect of lopinavir-ritonavir and lamivudine on oral health indicators (dental caries, gingivitis, tooth eruption, and oral health related quality of life) in 5 to 7 year old HIV-1 exposed uninfected children from the ANRS 12174 trial. METHODS: This study used data collected in 2017 among children aged 5 to 7 years from the Ugandan site of the ANRS 12174 randomized trial (ClinicalTrials.gov no: NCT00640263) implemented between 2009 and 2012 in Mbale district, Eastern Uganda. The intervention was lopinavir-ritonavir or lamuvudine treatment to prevent vertical HIV-1 transmission. One hundred thirty-seven and 139 children were randomized to receive lopinavir-ritonavir or lamivudine treatment at day 7 postpartum to compare efficacy of prevention of vertical HIV-1 transmission. At follow up, the children underwent oral examination using the World Health Organization methods for field conditions. The oral health related quality of life was assessed using the early childhood oral health impact scale. Negative binomial and logistic regression were used for the analysis of data. MAIN OUTCOME MEASURES: Dental caries, gingivitis, tooth eruption, and oral health related quality of life) in 5 to 7 year old HIV-1 exposed uninfected children. RESULTS: The prevalence of dental caries was 48% in the study sample: 49% in the lopinavir-ritonavir arm and 48% in the lamivudine treatment group. The corresponding mean decayed missing filled teeth and standard deviation was 1.7 (2.4) and 2.3 (3.7) The mean number (standard deviation) of erupted permanent teeth was 3.8 (3.7) and 4.6 (3.9) teeth in the lopinavir- and lamivudine group, respectively. The prevalence of reported impacts on oral health was 7% in the lopinavir-ritonavir and 18% in the lamivudine group. Gingivitis had a prevalence of 7% in the lopinavir-ritonavir and 14% lamivudine treatment group. The regression analysis revealed 70% less reported impacts on oral health in lopinavir-ritonavir group than the lamivudine treatment group with an incidence rate ratio of 0.3 (95% confidence interval: 0.1-0.9). CONCLUSIONS: HIV exposed uninfected infants in the lopinavir-ritonavir group reported less impacts on oral health than the lamivudine treatment group. Dental caries, gingivitis, and tooth eruption were not significantly affected by the treatment lopinavir-ritonavir or lamivudine. TRIAL REGISTRATION CLINICALTRIALS. GOV IDENTIFIER: NCT00640263.


Assuntos
Antirretrovirais/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Infecções por HIV/tratamento farmacológico , Saúde Bucal/estatística & dados numéricos , Fármacos Anti-HIV/farmacologia , Fármacos Anti-HIV/uso terapêutico , Estudos de Casos e Controles , Criança , Pré-Escolar , Cárie Dentária/tratamento farmacológico , Cárie Dentária/epidemiologia , Quimioterapia Combinada , Feminino , Gengivite/tratamento farmacológico , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , HIV-1/efeitos dos fármacos , Humanos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Lamivudina/farmacologia , Lamivudina/uso terapêutico , Lopinavir/farmacologia , Lopinavir/uso terapêutico , Masculino , Avaliação de Resultados em Cuidados de Saúde , Prevalência , Qualidade de Vida , Ritonavir/farmacologia , Ritonavir/uso terapêutico , Erupção Dentária/efeitos dos fármacos , Uganda/epidemiologia
20.
Am J Hum Genet ; 107(3): 473-486, 2020 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-32781046

RESUMO

Africa contains more human genetic variation than any other continent, but the majority of the population-scale analyses of the African peoples have focused on just two of the four major linguistic groups, the Niger-Congo and Afro-Asiatic, leaving the Nilo-Saharan and Khoisan populations under-represented. In order to assess genetic variation and signatures of selection within a Nilo-Saharan population and between the Nilo-Saharan and Niger-Congo and Afro-Asiatic, we sequenced 50 genomes from the Nilo-Saharan Lugbara population of North-West Uganda and 250 genomes from 6 previously unsequenced Niger-Congo populations. We compared these data to data from a further 16 Eurasian and African populations including the Gumuz, another putative Nilo-Saharan population from Ethiopia. Of the 21 million variants identified in the Nilo-Saharan population, 3.57 million (17%) were not represented in dbSNP and included predicted non-synonymous mutations with possible phenotypic effects. We found greater genetic differentiation between the Nilo-Saharan Lugbara and Gumuz populations than between any two Afro-Asiatic or Niger-Congo populations. F3 tests showed that Gumuz contributed a genetic component to most Niger-Congo B populations whereas Lugabara did not. We scanned the genomes of the Lugbara for evidence of selective sweeps. We found selective sweeps at four loci (SLC24A5, SNX13, TYRP1, and UVRAG) associated with skin pigmentation, three of which already have been reported to be under selection. These selective sweeps point toward adaptations to the intense UV radiation of the Sahel.


Assuntos
Adaptação Fisiológica/genética , Variação Genética/genética , Seleção Genética/genética , Pigmentação da Pele/genética , Grupo com Ancestrais do Continente Africano/genética , Antiporters/genética , Gerenciamento de Dados , Etiópia/epidemiologia , Feminino , Genética Populacional , Genoma Humano/genética , Haplótipos/genética , Humanos , Masculino , Glicoproteínas de Membrana/genética , Oxirredutases/genética , Polimorfismo de Nucleotídeo Único/genética , Nexinas de Classificação/genética , Proteínas Supressoras de Tumor/genética , Uganda/epidemiologia
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