Contextual and psychological factors influencing open defecation free status: an exploratory qualitative study in rural South Western Uganda.

INTRODUCTION: Achieving the Open defecation free (ODF) status remains a major challenge in Uganda, yet it contributes significantly to child health improvement. Literature on social, cultural and behavioral aspects that influence the ODF status in rural Uganda is limited. The study therefore, explored perceived factors influencing the ODF status in rural South Western Uganda. METHODS: An exploratory study employing qualitative techniques and based on deductive analysis between month December 2020 and January 2021 was conducted. Seven Focus Group Discussions (FGDs and three Key Informant Interviews (KIs) were conducted in Kabale District, southwestern Uganda. Focus Group Discussion participants were mothers and fathers having children of 2 years and below while KIIs included local community leaders and health extension workers. Data was analyzed using a categorization matrix derived from the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) model which is comprised of contextual and psychological factors. Text was further categorized into high and low statements for attainment of ODF status. RESULTS: The contextual factors influencing the Open Defecation Free status behavior included; farming activities far from home, financial constraints, rainy seasons, collapsible soft soils, and alcohol use. Psychological factors influencing ODF status included; perceived health risk for typhoid disease, low perceived severity for lack of ODF components, negative attitude of less value attached to ODF components, and a feeling of time wastage practicing ODF status behavior. The perception that the community has the ability to attain the ODF status was high. Although, the capability to maintain ODF was low when it comes to replacement of ODF component if stolen or destroyed. CONCLUSION: Open Defecation Free status is influenced by contextual and psychological factors. Therefore, it's crucial for sanitation promotors to always identify such context specific factors in order to design sanitation and hygiene promotion interventions to address the ODF free status related challenges.

Use of biomass fuels predicts indoor particulate matter and carbon monoxide concentrations; evidence from an informal urban settlement in Fort Portal city, Uganda.

BACKGROUND: Poor indoor air quality (IAQ) is a leading cause of respiratory and cardiopulmonary illnesses. Particulate matter (PM2.5) and carbon monoxide (CO) are critical indicators of IAQ, yet there is limited evidence of their concentrations in informal urban settlements in low-income countries. OBJECTIVE: This study assessed household characteristics that predict the concentrations of PM2.5 and CO within households in an informal settlement in Fort Portal City, Uganda. METHODOLOGY: A cross-sectional study was conducted in 374 households. Concentrations of PM2.5 and CO were measured using a multi-purpose laser particle detector and a carbon monoxide IAQ meter, respectively. Data on household characteristics were collected using a structured questionnaire and an observational checklist. Data were analysed using STATA version 14.0. Linear regression was used to establish the relationship between PM2.5, CO concentrations and household cooking characteristics. RESULTS: The majority (89%, 332/374) of the households used charcoal for cooking. More than half (52%, 194/374) cooked outdoors. Cooking areas had significantly higher PM2.5 and CO concentrations (t = 18.14, p ≤ 0.05) and (t = 5.77 p ≤ 0.05), respectively. Cooking outdoors was associated with a 0.112 increase in the PM2.5 concentrations in the cooking area (0.112 [95% CI: -0.069, 1.614; p = 0.033]). Cooking with moderately polluting fuel was associated with a 0.718 increase in CO concentrations (0.718 [95% CI: 0.084, 1.352; p = 0.027]) in the living area. CONCLUSIONS: The cooking and the living areas had high concentrations of PM2.5 and CO during the cooking time. Cooking with charcoal resulted in higher CO in the living area. Furthermore, cooking outdoors did not have a protective effect against PM2.5, and ambient PM2.5 exceeded the WHO Air quality limits. Interventions to improve the indoor air quality in informal settlements should promote a switch to cleaner cooking energy and improvement in the ambient air quality.

Organophosphate and carbamate insecticide exposure is related to lung function change among smallholder farmers: a prospective study.

INTRODUCTION AND AIM: Exposure to some insecticides may cause airway obstruction, but existing evidence is limited by cross-sectional designs and inadequate confounder control. We investigated the relation between organophosphate and carbamate insecticides and pulmonary function in a prospective study accounting for important confounders. METHODS: In a cohort of 364 smallholder farmers in Uganda (69% women), participants underwent pre-bronchodilator spirometry at baseline (September/October 2018) and at two follow-up visits (November/December 2018 and January/February 2019). Exposure to carbamate and organophosphate insecticides was assessed using haemoglobin-adjusted erythrocyte acetylcholinesterase (AChE/Hb). Less than 3% of participants were lost to follow-up. We calculated Z-scores for FEV1, FVC and FEV1/FVC using the Global Lung Function Initiative equations. Data were analysed in linear mixed and fixed effect models accounting for family relationships and repeated measures of exposure and outcome. RESULTS: Low AChE/Hb was significantly associated with low FEV1 Z-score in both unadjusted and adjusted analyses. Compared with individuals with AChE/Hb 25.90 U/g (50th percentile, reference), those with lower AChE/Hb 24.50 U/g (35th percentile) had mean FEV1 Z-score 0.045 (0.003 to 0.087) lower, and persons with higher AChE/Hb 27.30 U/g (65th percentile) had a mean FEV1 Z-score 0.043 (-0.002 to 0.087) higher compared with the reference. Similar, but numerically smaller and statistically non-significant effects were seen for Z-scores of FVC and FEV1/FVC. CONCLUSION: Exposure to organophosphate and carbamate insecticides may lead to lung function decline. Our results add to the growing evidence of health effects in relation to exposure to organophosphate and carbamate insecticides, underlining the importance of minimising exposure.

Factors associated with health facility deliveries among mothers living in hospital catchment areas in Rukungiri and Kanungu districts, Uganda.

BACKGROUND: Health facility deliveries are generally associated with improved maternal and child health outcomes. However, in Uganda, little is known about factors that influence use of health facilities for delivery especially in rural areas. In this study, we assessed the factors associated with health facility deliveries among mothers living within the catchment areas of major health facilities in Rukungiri and Kanungu districts, Uganda. METHODS: Cross-sectional data were collected from 894 randomly-sampled mothers within the catchment of two private hospitals in Rukungiri and Kanungu districts. Data were collected on the place of delivery for the most recent child, mothers' sociodemographic and economic characteristics, and health facility water, sanitation and hygiene (WASH) status. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the determinants of health facility deliveries as well as factors associated with private versus public utilization of health facilities for childbirth. RESULTS: The majority of mothers (90.2%, 806/894) delivered in health facilities. Non-facility deliveries were attributed to faster progression of labour (77.3%, 68/88), lack of transport (31.8%, 28/88), and high cost of hospital delivery (12.5%, 11/88). Being a business-woman [APR = 1.06, 95% CI (1.01-1.11)] and belonging to the highest wealth quintile [APR = 1.09, 95% CI (1.02-1.17)] favoured facility delivery while a higher parity of 3-4 [APR = 0.93, 95% CI (0.88-0.99)] was inversely associated with health facility delivery as compared to parity of 1-2. Factors associated with delivery in a private facility compared to a public facility included availability of highly skilled health workers [APR = 1.15, 95% CI (1.05-1.26)], perceived higher quality of WASH services [APR = 1.11, 95% CI (1.04-1.17)], cost of the delivery [APR = 0.85, 95% CI (0.78-0.92)], and availability of caesarean services [APR = 1.13, 95% CI (1.08-1.19)]. CONCLUSION: Health facility delivery service utilization was high, and associated with engaging in business, belonging to wealthiest quintile and having higher parity. Factors associated with delivery in private facilities included health facility WASH status, cost of services, and availability of skilled workforce and caesarean services.

Exposure to cholinesterase inhibiting insecticides and blood glucose level in a population of Ugandan smallholder farmers.

OBJECTIVES: The risk of diabetes mellitus may be elevated among persons exposed to some pesticides, including cholinesterase-inhibiting insecticides (organophosphates and carbamates). The objective of this study was to investigate how acetylcholinesterase activity was associated with mean blood glucose levels among smallholder farmers in Uganda. METHODS: We conducted a short-term follow-up study among 364 smallholder farmers in Uganda. Participants were examined three times from September 2018 to February 2019. At each visit, we measured glycosylated haemoglobin A (HbA1c) as a measure of long-term average blood glucose levels. Exposure to organophosphate and carbamate insecticides was quantified using erythrocyte acetylcholinesterase normalised by haemoglobin (AChE/Hb). For a subgroup of participants, fasting plasma glucose (FPG) was also available. We analysed HbA1c and FPG versus AChE/Hb in linear mixed and fixed effect models adjusting for age, sex, physical activity level, and consumption of fruits and vegetables, alcohol and tobacco. RESULTS: Contrary to our hypothesis, our mixed effect models showed significant correlation between low AChE/Hb and low HbA1c. Adjusted mean HbA1c was 0.74 (95% CI 0.17 to 1.31) mmol/mol lower for subjects with AChE/Hb=24.3 U/g (35th percentile) compared with subjects with AChE/Hb=25.8 U/g (50th percentile). Similar results were demonstrated for FPG. Fixed effect models showed less clear correlations for between-phase changes in AChE/Hb and HbA1c. CONCLUSIONS: Our results do not clearly support a causal link between exposure to cholinesterase-inhibiting insecticides and elevated blood glucose levels (expressed as HbA1c and FPG), but results should be interpreted with caution due to the risk of reverse causality.

Assessment of water, sanitation and hygiene service availability in healthcare facilities in the greater Kampala metropolitan area, Uganda.

BACKGROUND: Improved Water, Sanitation and Hygiene (WASH) in Healthcare facilities (HCFs) is of significant public health importance. It is associated with a reduction in the transmission of healthcare acquired infections (HAIs), increased trust and uptake of healthcare services, cost saving from infections averted, increased efficiency and improved staff morale. Despite these benefits, there is limited evidence on availability of WASH services in HCFs in the Greater Kampala Metropolitan Area (GKMA). This study assessed the availability and status of WASH services within HCFs in the GKMA in order to inform policy and WASH programming. METHODS: A cross-sectional study was conducted in 60 HCFs. Availability of WASH services in the study HCFs was assessed using a validated WASH Conditions (WASHCon) tool comprising of structured interviews, HCF observations and microbial water quality analysis. Data were analysed using Stata 14 software and R software. RESULTS: Overall, 84.5% (49/58) and 12.1% (7/58) of HCFs had limited and basic WASH service respectively. About 48.3% (28/58) had limited water service, 84.5% (49/58) had limited sanitation service, 50.0% (29/58) had limited environmental cleanliness service, 56.9% (33/58) had limited hand hygiene service, and 51.7% (30/58) had limited waste management service. About 94.4% of public HCFs had limited WASH service compared to only 68.2% of private not for profit facilities. More health centre IIIs, 92.5% and health centre IVs (85.7%) had limited WASH service compared to hospitals (54.5%). CONCLUSIONS: Our findings indicate that provision of water, sanitation, hand hygiene, environmental cleanliness, and health care waste management services within HCFs is largely hindered by structural and performance limitations. In spite of these limitations, it is evident that environmental cleanliness and treatment of infectious waste can be attained with better oversight and dedicated personnel. Attaining universal WASH coverage in HCFs will require deliberate and strategic investments across the different domains.

Schistosomiasis infection in pre-school aged children in Uganda: a qualitative descriptive study to identify routes of exposure.

BACKGROUND: Prevalence of schistosomiasis is high among children under five years in Uganda. Schistosomiasis control efforts over time have included periodic mass treatments in endemic areas for adults and school going children aged 5 years and above. This study explores behaviour practices of children age 2-4 years that increase the risk of schistosomiasis infection in this age group. METHODS: A qualitative descriptive study was conducted using in-depth interviews with 30 caregivers of children aged 2-4 years who tested positive for schistosomiasis in a national prevalence survey in 2017. Observations were done at water bodies where young children go with caretakers or other older children. The study was conducted in three Ugandan sub-regions of West Nile and East-central, and South-western with high, and low prevalence of schistosomiasis, respectively. Data were thematically analysed. Anonymised supporting photos from observations are also presented. RESULTS: Knowledge about schistosomiasis transmission was poor among caregivers, who concurrently had mixed right and wrong information. Reported avenues for contracting schistosomiasis included both correct: contact activities with infested water, and incorrect modes: contact with dirty water, sharing bathrooms, witchcraft, polluted air and contaminated food. The children in this study could have contracted schistosomiasis through the contact with infested water during activities such as bathing and playing, while their caregivers washed clothes, collected snail shells for poultry feeds, fetched water at the water bodies. These activities were reported by caregivers and observed in all study areas. Evidence of open defecation and urination in and near water bodies by adults and children was also observed. CONCLUSIONS: Pre-school children age 2-4 years are at a high risk of exposure to schistosomiasis while caretakers conduct activities in infested water bodies. There is need for prevention interventions to target children in their early stages of life to control schistosomiasis in this vulnerable population.

Determinants of occupational injuries among building construction workers in Kampala City, Uganda.

BACKGROUND: Globally, about 1000 people die and close to 860,000 people sustain injury at work daily. Injury prevention and control require contextual evidence, although most studies in Uganda have focused on general causes. Factors associated with occupational injuries among building construction workers were assessed in this study. METHODS: A cross-sectional study among building construction workers was conducted in Kampala, Uganda. A standardized semi-structured questionnaire was used to collect data. Three hundred nineteen (319) participants were randomly and proportionately selected from 57 construction sites. Descriptive statistics were used to describe the variables while generalized linear modeling was used to estimate the crude/adjusted prevalence ratios. RESULTS: The prevalence of occupational injuries was 32.4%. Most injuries, approximately 70% occurred among nightshift workers. Age of ≤24 years (APR: 2.09 CI: 1.20-3.65, P = 0.009); daily income in or above the second quartile-USD ≥3.2 (APR: 1.72, CI: 1.06-2.80, P = 0.028); job dissatisfaction (APR: 1.63, CI: 1.17-2.27, P = 0.004); job stress (APR: 1.72, CI: 1.22-2.41, P = 0.004); poor safety environment (APR: 1.51, CI: 1.10-2.05, P = 0.009); PPE provision (APR: 1.47, CI: 1.05-2.05, P = 0.02) and routine use of PPE (APR: 0.57, CI: 0.34-0.95, P = 0.03) were significantly associated with occupational injuries. CONCLUSION: There was a relatively high prevalence of injuries mostly resulting from cuts and mostly suffered on night duty. Upper and lower extremities were the most hurt parts of the body during injury leading to loss of a substantial number of productive days. This could affect the health and wellbeing of construction workers. Most of the factors significantly associated with occupational injuries are modifiable thus an opportunity to address the problem. Efforts towards integrating education for behaviour change, advocacy and training workers to demand for their rights to safe and protection at work and legislation enforcement can help reduce occupational injury occurrence.

Factors associated with willingness to take up indoor residual spraying to prevent malaria in Tororo district, Uganda: a cross-sectional study.

BACKGROUND: Indoor residual spraying (IRS) is an efficient method of preventing malaria in homes, and community willingness to take up IRS is critical to its success. The first phase of IRS was conducted in Tororo district, Uganda between December 2014 and January 2015. High coverage rates (90%) were attained in the district. However, Mulanda sub-county had the lowest coverage of 78%, in the first round. This study assessed willingness and associated factors of IRS uptake among household heads for the next IRS campaign in Mulanda sub-county, Tororo district. METHODS: A household survey was conducted in all three parishes of Mulanda sub-county. A multistage sampling technique involving the village and household as the first and second sampling levels, respectively, was used to identify 640 households Household heads were interviewed using standard questionnaire. Seven key informants were also conducted to explore the impact of community IRS-perceptions on uptake. Bi-variable and multi-variable logistic regression analyses were used to identify factors associated with willingness to take up IRS. Qualitative data was analysed by thematic content analysis method. RESULTS: Most (79.9%) respondents were willing to take up repeat IRS. However this was below the target of 85%. Fear of insecticide adverse effects (62%) was the most common reason mentioned by 134 (21%) household heads who were not willing to take up IRS. Factors associated with to take up IRS were; age ≥ 35 years (AOR 1.9; 95% CI 1.08-3.51), higher socio-economic status (AOR 0.4; 95% CI 0.27-0.98), not taking IRS in previous round (AOR 0.1; 95% CI 0.06-0.23), not knowing reason for conducting IRS (AOR 0.4; 95% CI 0.24-0.78) and having an iron sheet roof (AOR 2.2; 95% CI 1.03-4.73). Community and religious leaders were the preferred sources of IRS information. CONCLUSIONS: The level of willingness to take up IRS was low (79%) compared to the targeted 85%. Involvement of community and religious leaders in community sensitization on the efficacy and safety of the chemicals could increase uptake of IRS.

Women's intention to screen and willingness to vaccinate their daughters against cervical cancer - a cross sectional study in eastern Uganda.

BACKGROUND: The World Health Organization recommends cervical cancer screening and vaccination programmes as measures to combat cervical cancer. The uptake of these measures remains low in Uganda, most especially in rural areas. An understanding of the factors that influence women's decision to attend screening, and willingness to have their daughters vaccinated against cervical cancer is essential for any attempts to increase uptake of these services. This study assessed the factors associated with intention to screen for cervical cancer among women in eastern Uganda, and willingness to have their daughters vaccinated against the disease. METHODS: This cross sectional study involved 900 females aged 25 to 49 years in Bugiri and Mayuge districts in eastern Uganda. Data were collected using a pretested semi-structured questionnaire, entered in Epidata version 3.02 and analysed in STATA version 12.0. Unadjusted and adjusted prevalence ratios (PR) were computed using a generalized linear model with Poisson family, and a log link with robust standard errors. RESULTS: Majority 819 (91.0%) of respondents stated that they intended to go for cervical cancer screening in the subsequent six months. Among them, 603 (73.6%) wanted to know their status, 256 (31.3%) thought it was important, 202 (24.7%) wanted to reduce their chances of getting the disease, and 20 (2.4%) had been told to do so by a health worker. Majority 813 (90.4%) of respondents were willing to vaccinate their daughters against cervical cancer. Higher income (adjusted PR = 1.11, 95% CI: 1.03-1.20), cervical cancer screening status (adjusted PR = 0.81, 95% CI: 0.67-0.99) and knowledge of at least one test for cervical cancer (adjusted PR = 0.92, 95% CI: 0.85-0.98) were significantly associated with intention to screen for cervical cancer. No socio-demographic characteristic was associated with willingness to vaccinate daughters among women. CONCLUSION: There is a very high intention to screen and willingness to vaccinate daughters against cervical cancer among women in eastern Uganda. To take advantage of this, there is need to avail opportunities for women to access cervical cancer screening and vaccinations particularly among rural communities.

Nottingham Trent University and Makerere University School of Public Health partnership: experiences of co-learning and supporting the healthcare system in Uganda.

Partnerships between developed and developing country institutions are increasingly becoming important in addressing contemporary global health challenges faced by health systems. Inter-university health collaboration such as the Nottingham Trent University (UK) and Makerere University School of Public Health (Uganda) partnership provide opportunities for working together in training, research and service delivery while strengthening health systems. This paper shares the experiences, achievements and opportunities of this partnership in co-learning and supporting the health system in Uganda. This includes a project being implemented to strengthen the training, supervision and motivation of community health workers in rural Uganda. Training and research are a key focus of the partnership and have involved both staff and students of both institutions including guest lectures, seminars and conference presentations. The partnership's collaboration with stakeholders such as the Ministry of Health (Uganda) and local health authorities has ensured participation necessary in supporting implementation of sustainable interventions. The partnership uses several channels such as email, telephone, Skype, Dropbox and WhatsApp which have been useful in maintaining constant and effective communication. The challenges faced by the partnership include lack of funding to support student mobility, and varying academic schedules of the two institutions. The experiences and prospects of this growing partnership can inform other collaborations in similar settings.

Integrated approach to malaria prevention at household level in rural communities in Uganda: experiences from a pilot project.

BACKGROUND: Malaria is a major public health challenge in sub-Saharan Africa. In Uganda, malaria is the leading cause of morbidity and mortality especially among children under five years of age. This pilot project promoted prevention of malaria at household level using an integrated approach in two rural communities in Wakiso District, Uganda. This involved advocating and implementing several strategies in a holistic manner geared towards reduction in the occurrence of malaria. The specific strategies involved can be classified as: 1) personal protection - use of insecticide-treated bed nets and insecticide sprays; 2) reducing mosquito breeding sites - draining pools of water, larviciding and clearing unnecessary vegetation around homes; and 3) reducing entry of mosquitoes into houses - installing mosquito proofing in windows, ventilators and open eaves, and closing windows and doors early in the evenings. CASE DESCRIPTION: The objectives of the project were to: carry out a baseline survey on malaria prevention; train community health workers and increase awareness among the community on the integrated approach to malaria prevention; and, establish demonstration sites using the integrated approach. A baseline survey among 376 households was conducted which generated information on the knowledge, attitudes and practices of the community in relation to malaria prevention. The project trained 25 community health workers and over 200 community members were sensitized on the integrated approach to malaria prevention. In addition, 40 demonstration households using the integrated approach were established. DISCUSSION AND EVALUATION: The use of multiple methods in the prevention of malaria was appreciated by the community particularly the demonstration households using the integrated approach. Initial project evaluation showed that the community had become more knowledgeable about the various malaria prevention methods that were advocated in the integrated approach. In addition, some of the methods that were not being used before project implementation, such as early closing of windows, had been adopted. The presence of mosquitoes in the demonstration households had also reduced. CONCLUSION: The integrated approach to malaria prevention at household level was well perceived by the project community, which could be scaled up to other areas. More rigorous studies such as randomized controlled trials are also recommended to further explore the public health impact of the integrated approach to malaria prevention.

Consumer Awareness and Health Risk Perceptions of Pesticide Residues in Fruits and Vegetables in Kampala Metropolitan Area in Uganda.

Consumer awareness of the presence of pesticides in fruits and vegetables and associated health risks influences the actions they undertake to reduce their exposure. This study was carried out to explore consumers' awareness of pesticide residues in fruits and vegetables and perceptions towards associated health effects in Kampala Metropolitan Area (KMA) in Uganda. Eight focus group discussions (FGDs) were done with fruit and vegetables consumers in KMA. The FGDs consisted of females and males living in urban and rural areas. Discussions were recorded and transcribed. The transcripts were coded inductively and analysed using conventional content analysis. Consumers were aware of the presence of pesticide residues in fruits and vegetables. Non-compliance to good agricultural practices, desire to produce good quality fruits and vegetables, and conflict of interest were thought to be the underlying reasons for the contamination. Consumers thought that their health is at risk of chronic and acute health effects, and that this risk is unavoidable. They emphasized that long term exposure to the pesticide residues puts them at risk of conditions like reproductive defects and noncommunicable diseases like cancer, hypertension, obesity, kidney and heart diseases among others. To reduce the risk, consumers were aware of and relied on mitigation measures including washing, peeling, drying and cooking or applied them in combination. Consumers were aware of the presence of pesticide residues on fruits and vegetables, potential short and long term health risks due to exposure, and domestic processing methods to reduce health risks. There is need for authorities to ensure adherence to good agricultural practices and ensure that farmers and consumers understand that pesticide are used to control pests and disease but not to primarily increase shelf life of fruits and vegetables.

Capacity of enforcers and level of enforcement of the Tobacco Control Act 2015 in Kampala, Uganda.

Tobacco use is a leading cause of preventable deaths worldwide. Uganda enacted the Tobacco Control Act (TCA) 2015 to domesticate implementation of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) regulations. This study assessed the capacity to enforce the TCA and associated factors, as well as the level and barriers to its enforcement in Kampala, Uganda. A cross-sectional study using both quantitative and qualitative methods was employed. A structured questionnaire was used for quantitative data collection, and a WHO adapted capacity assessment open-ended guide was used for key informant interviews. Multivariable logistic regression was used to obtain odds ratios and 95% confidence intervals for the independent predictors for capacity to enforce the TCA. A total of 162 respondents from 5 institutions and six key informants were involved in the study. Findings established that only 23% (37/162) of the enforcers had the capacity to enforce the TCA. Male enforcers [OR = 0.16, 95% CI (0.05-0.55)], those who did not know when the law was enacted [OR = 0.19, 95% CI (0.07-0.52)], those with no plans to enforce the law [OR = 0.22, 95% CI (0.05-0.93)], and older enforcers (aged 31-40 years) [OR = 0.27, 95% CI (0.09-0.81)] were less likely to have the capacity to enforce the TCA. The level of enforcement of the TCA was mainly low to moderate for most of the institutions mandated to enforce it. Lack of knowledge about the law amongst the enforcers and general public, and inadequate funds were reported as major barriers to enforcement of the TCA. The capacity to enforce the TCA in Kampala was low. There is potential to enhance the capacity of enforcers through further dissemination of the Act, as well as sensitization of enforcers, institutional managers, and the general public about the legislation.

Association between recent COVID-19 diagnosis, depression and anxiety symptoms among slum residents in Kampala, Uganda.

BACKGROUND: Despite the known link between poor living conditions and mental health, there has been little research on the mental health of slum dwellers worldwide. Although the Coronavirus disease 2019 (COVID-19) pandemic has led to an increase in mental health issues, little focus has been given to the impact on slum dwellers. The study aimed to investigate the association between recent COVID-19 diagnosis and the risk of depression and anxiety symptoms among people living in an urban slum in Uganda. METHODS: A cross-sectional study was conducted among 284 adults (at least 18 years of age) in a slum settlement in Kampala, Uganda between April and May 2022. We assessed depression symptoms and anxiety using validated Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder assessment tool (GAD-7) questionnaires respectively. We collected data on sociodemographic characteristics, and self-reported recent COVID-19 diagnosis (in the previous 30 days). Using a modified Poisson regression, adjusted for age, sex, gender and household income, we separately provided prevalence ratios and 95% confidence intervals for the associations between recent COVID-19 diagnosis and depressive and anxiety symptoms. RESULTS: Overall, 33.8% and 13.4% of the participants met the depression and generalized anxiety screening criteria respectively and 11.3% were reportedly diagnosed with COVID-19 in the previous 30 days. People with recent COVID-19 diagnosis were more likely to be depressed (53.1%) than those with no recent diagnosis (31.4%) (p<0.001). Participants who were recently diagnosed with COVID-19 reported higher prevalence of anxiety (34.4%) compared to those with no recent diagnosis of COVID-19 (10.7%) (p = 0.014). After adjusting for confounding, recent diagnosis with COVID-19 was associated with depression (PR = 1.60, 95% CI 1.09-2.34) and anxiety (PR = 2.83, 95% CI 1.50-5.31). CONCLUSION: This study suggests an increased risk of depressive symptoms and GAD in adults following a COVID-19 diagnosis. We recommend additional mental health support for recently diagnosed persons. The long-term of COVID-19 on mental health effects also need to be investigated.

Chemical contaminant exposures assessed using silicone wristbands among fuel station attendants, taxi drivers and commercial motorcycle riders in Kampala, Uganda.

There are concerns over traffic-related air pollution in Uganda's capital, Kampala. Individuals in the transportation sector are hypothesized to be at greater risk for exposure to volatile organic compounds, given their proximity to vehicle exhaust. Silicone wristbands are a wearable technology that passively sample individuals' chemical exposures. We conducted a pilot cross sectional study to measure personal exposures to volatile organic compounds among 14 transportation workers who wore a wristband for five days. We analyzed for 75 volatile organic compounds; 33 chemicals (35%) were detected and quantified in at least 50% of the samples and 15 (16%) chemicals were detected and quantified across all the samples. Specific chemicals were associated with participants' occupation. The findings can guide future large studies to inform policy and practice to reduce exposure to chemicals in the environment in Kampala.

Indoor air pollutants and respiratory symptoms among residents of an informal urban settlement in Uganda: A cross-sectional study.

BACKGROUND: Indoor air pollutants (IAP) and household conditions such as dampness, crowding and chemical exposures have been associated with acute and chronic respiratory infections. In Uganda, literature on the effects of IAP on respiratory outcomes in informal settlements is limited. METHODS: We describe the baseline household characteristics of 284 adults and their children in an informal settlement in Uganda from April to May 2022. We monitored same-day indoor concentrations of particulate matter PM2.5, PM10, Carbon monoxide (CO), relative humidity %, and temperature from 9 am to 2 pm and interviewed caregivers/mothers about their respiratory symptoms and those of their children in the previous 30 days. We employed robust Poisson regressions to evaluate the associations between indoor air indicators and respiratory health symptoms. RESULTS: Approximately 94.7% of households primarily used biomass fuels and 32.7% cooked from inside their dwelling rooms. The median PM2.5, PM10 and CO levels were 49.5 (Interquartile range (IQR) = 31.1,86.2) µg/m3, 73.6 (IQR = 47.3,130.5) µg/m3 and 7.70 (IQR = 4.1,12.5) ppm respectively. Among adults, a 10 unit increase in PM2.5 was associated with cough (Prevalence Ratio (PR) = 3.75, 95%CI 1.15-1.55). Dwelling unit dampness was associated with phlegm (PR = 2.53, 95%CI = 1.39-4.61) and shortness of breath (PR = 1.78, 95% CI 1.23-2.54) while cooking from outside the house was protective against shortness of breath (PR = 0.62, 95% CI = 0.44-0.87). In children, dampness was associated with phlegm (PR = 13.87, 95% CI 3.16-60.91) and cough (PR = 1.62, 95% CI 1.12-2.34) while indoor residual spraying was associated with phlegm (PR = 3.36, 95%CI 1.71-6.61). CONCLUSION: Poor indoor air conditions were associated with respiratory symptoms in adults and children. Efforts to address indoor air pollution should be made to protect adults and children from adverse health effects.

Epidemiology of extended-spectrum beta-lactamase-producing Escherichia coli at the human-animal-environment interface in a farming community of central Uganda.

BACKGROUND: Extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-Ec) represents a significant global public health concern. The epidemiology of ESBL-Ec in Uganda is not well understood although it is harbored by humans, animals, and the environment. This study explains the epidemiology of ESBL-Ec using a one health approach in selected farming households in Wakiso district, Uganda. METHODOLOGY: Environmental, human, and animal samples were collected from 104 households. Additional data were obtained using observation checklists and through interviews with household members using a semi-structured questionnaire. Surface swabs, soil, water, human and animal fecal samples were introduced onto ESBL chromogenic agar. The isolates were identified using biochemical tests and double-disk synergy tests. To assess associations, prevalence ratios (PRs) were computed using a generalized linear model (GLM) analysis with modified Poisson and a log link with robust standard errors in R software. RESULTS: Approximately 83% (86/104) households had at least one positive ESBL-Ec isolate. The overall prevalence of ESBL-Ec at the human-animal-environment interface was approximately 25.0% (95% CI: 22.7-28.3). Specifically, humans, animals and the environment had an ESBL-Ec prevalence of 35.4%, 55.4%, and 9.2% respectively. Having visitors (adj PR = 1.19, 95% CI: 1.04-1.36), utilizing veterinary services (adj PR = 1.39, 95% CI: 1.20-1.61) and using animal waste for gardening (adj PR = 1.29, 95% CI: 1.05-1.60) were positively associated with household ESBL-Ec contamination. Covering the drinking water container with a lid (adj PR = 0.84 95% CI: 0.73-0.96) was associated with absence of ESBL-Ec in a household. CONCLUSION: There is wider dissemination of ESBL-Ec in the environment, humans, and animals, indicating poor infection prevention and control (IPC) measures in the area. Improved collaborative one health mitigation strategies such as safe water chain, farm biosecurity, household and facility-based IPC measures are recommended to reduce the burden of antimicrobial resistance at community level.

Antimicrobial resistance among farming communities in Wakiso District, Central Uganda: A knowledge, awareness and practice study.

BACKGROUND: Antibiotics are increasingly becoming ineffective as antimicrobial resistance (AMR) continues to develop and spread globally-leading to more difficult to treat infections. Countries such as Uganda are still challenged with implementation of AMR related strategies due to data paucity. This includes a lack of data on the prevailing knowledge and awareness of antimicrobial resistance and antibiotic use among farming communities, both commercial and subsistence, which are instrumental in the implementation of targeted interventions. The aim of our study was to assess the knowledge, attitudes and practices on AMR among subsistence and commercial farmers in Wakiso district, central Uganda. METHODS: A cross-sectional study was conducted using a semi-structured questionnaire in Wakiso district, Central Uganda in between June and September 2021. Polytomous latent class analyses were performed to group participants based on their responses. Multivariable regression and conditional inference trees were used to determine the association between demographic factors and knowledge on antibiotics and AMR. RESULTS: A total of 652 respondents participated in the study among whom 84% were able to correctly describe what antibiotics are. Subsistence farmers (OR = 6.89, 95% CI [3.20; 14.83]), and to a lesser extent, farming community members which obtained their main income by another business (OR = 2.25, 95% CI [1.345; 3.75]) were more likely to be able to describe antibiotics correctly than individuals involved in commercial farming. Based on the latent class analysis, three latent classes indicating different levels of knowledge on AMR, were found. Subsistence farming, higher educational level and younger age were found to be associated with belonging to a class of better knowledge. CONCLUSION: The majority of participants were able to correctly describe antibiotics and aware of AMR, however there was some degree of misunderstanding of several AMR concepts. Targeted AMR interventions should improve awareness and also ensure that not only subsistence farmers, but commercial farmers, are included.

Phenotypic Characterization and Antibiograms of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli Isolated at the Human-Animal-Environment Interface Using a One Health Approach Among Households in Wakiso District, Uganda.

Background: The occurrence of extended spectrum beta-lactamase (ESBL) producing bacteria such as Escherichia coli has increasingly become recognized beyond hospital settings. Resistance to other types of antibiotics limits treatment options while the existence of such bacteria among humans, animals, and the environment is suggestive of potential zoonotic and reverse-zoonotic transmission. This study aimed to establish the antibiotic susceptibility profiles of the ESBL-producing Escherichia coli (ESBL-EC) from human, animal, and environmental isolates obtained among farming households within Wakiso district using a One Health approach. Methods: A total of 100 ESBL-EC isolates from humans 35/100 (35%), animals 56/100 (56%), and the environment 9/100 (9%) were tested for susceptibility to 11 antibiotics. This was done using the Kirby-Bauer disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Data were analyzed in STATA ver. 16 and graphs were drawn in Microsoft excel ver. 10. Results: Most of the ESBL-EC isolates (98%) were resistant to more than two antibiotics. ESBL-EC isolates were most susceptible to meropenem (MEM) (88.0%), and imipenem (82.0%) followed by gentamicin (72%). ESBL-EC isolates from humans were most susceptible to meropenem (MEM) followed by imipenem (IPM)> gentamicin (CN)> ciprofloxacin (CIP). Animal samples were more susceptible to MEM, IPM, and CN but were highly resistant to cefotaxime (CTX)> cefepime (FEP)>other antibiotics. Multidrug resistance (MDR) was mostly reported among households keeping goats under intensive husbandry practices. Seven percent of the isolates exhibited carbapenem resistance while 22% showed aminoglycoside resistance. Similar resistance patterns among humans, animals, and environmental samples were also reported. Conclusion: Our study provides baseline information on non-hospital-based MDR caused by ESBL-EC using a One Health approach. ESBL-EC isolates were prevalent among apparently healthy community members, animals, and their environment. It is important to conduct more One Health approach studies to generate evidence on the drivers, resistance patterns, and transmission of ESBL-producing organisms at the human-animal-environmental interface.