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Nayiga S, MacPherson EE, Mankhomwa J, Nasuwa F, Pongolani R, Kabuleta R, Kesby M, Dacombe R, Hilton S, Grace D, Feasey N, Chandler CI. "Arming half-baked people with weapons!" Information enclaving among professionals and the need for a care-centred model for antibiotic use information in Uganda, Tanzania and Malawi. Glob Health Action 2024; 17:2322839. [PMID: 38441912 PMCID: PMC10916894 DOI: 10.1080/16549716.2024.2322839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The overuse of antimicrobial medicines is a global health concern, including as a major driver of antimicrobial resistance. In many low- and middle-income countries, a substantial proportion of antibiotics are purchased over-the-counter without a prescription. But while antibiotics are widely available, information on when and how to use them is not. OBJECTIVE We aimed to understand the acceptability among experts and professionals of sharing information on antibiotic use with end users - patients, carers and farmers - in Uganda, Tanzania and Malawi. METHODS Building on extended periods of fieldwork amongst end-users and antibiotic providers in the three countries, we conducted two workshops in each, with a total of 44 medical and veterinary professionals, policy makers and drug regulators, in December 2021. We carried out extensive documentary and literature reviews to characterise antibiotic information systems in each setting. RESULTS Participants reported that the general public had been provided information on medicine use in all three countries by national drug authorities, health care providers and in package inserts. Participants expressed concern over the danger of sharing detailed information on antibiotic use, particularly that end-users are not equipped to determine appropriate use of medicines. Sharing of general instructions to encourage professionally-prescribed practices was preferred. CONCLUSIONS Without good access to prescribers, the tension between enclaving and sharing of knowledge presents an equity issue. Transitioning to a client care-centred model that begins with the needs of the patient, carer or farmer will require sharing unbiased antibiotic information at the point of care.
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Affiliation(s)
- Susan Nayiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Eleanor E MacPherson
- Research and Innovation Services, University of Glasgow, Glasgow, UK
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
| | - John Mankhomwa
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
| | | | | | - Rita Kabuleta
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Mike Kesby
- School of Geography & Sustainable Development, University of St Andrews, St Andrews, UK
| | - Russell Dacombe
- Research and Innovation Services, University of Glasgow, Glasgow, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Delia Grace
- Natural Resources Institute, University of Greenwich, Chatham, UK
- International Livestock Research Institute, Nairobi, Kenya
| | - Nicholas Feasey
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
- The School of Medicine, University of St Andrews, St Andrews, UK
| | - Clare I.R. Chandler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Mohammed S, Calvert C, O Mugisha J, Ronald M, Asiki G, R Glynn J, Oakley LL, Marston M. Association between breastfeeding duration and educational attainment in rural Southwest Uganda: a population-based cohort study. Glob Health Action 2024; 17:2338023. [PMID: 38652548 DOI: 10.1080/16549716.2024.2338023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Breastfeeding is important for early childhood nutrition and health. The positive effects on educational outcomes may be attributed to socioeconomic factors. Socioeconomic status is not a strong predictor of breastfeeding in sub-Saharan African countries. Yet, few studies have investigated the association between breastfeeding and educational outcomes in these countries. OBJECTIVE This study investigated the association between breastfeeding duration and children's educational attainment in rural Southwest Uganda. METHODS We analysed longitudinal data on 3018 children who had information on breastfeeding and were followed for at least 5 years, with at least one primary school grade recorded by 2005. Data on breastfeeding duration were collected from mothers. The highest school grade was recorded repeatedly between ages 6 and 12 years. We calculated age-for-grade based on whether a child was on, over, or under the official age for a grade. Generalised estimating equations and binary logistic regression estimated the effect of breastfeeding duration on being 2 years, 3 or more years, or any years over-age for grade in primary school, adjusting for socioeconomic status and maternal-child characteristics. RESULTS Most mothers breastfed for more than a year. Just over one-third breastfed for 18-23 months, and 30% breastfed for longer. By age eight, 42% of the children were two years over-age for their grade. Three or more years over-age for grade increased from 19% at age nine to 56% at age 12. Both adjusted and unadjusted estimates were consistent in showing reduced odds for children being 2 years, 3 or more years, or any years over-age for grade among children breastfed for 7-12, 13-17, 18-23, and > 23 months compared to those breastfed for 0-6 months. There was no evidence to support an overall association between breastfeeding duration and being over-age for grade. There was no evidence of association in the sex and age sub-group analyses. CONCLUSION Although we found no association between breastfeeding duration and educational attainment, breastfeeding remains important for children's health and nutrition, and mothers should be encouraged and supported to breastfeed for the recommended duration.
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Affiliation(s)
- Shamsudeen Mohammed
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Clara Calvert
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Makanga Ronald
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Gershim Asiki
- African Population and Health Research Center (APHRC), Nairobi, Uganda
| | - Judith R Glynn
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Laura L Oakley
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Milly Marston
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Abstract
Ugandan urban same-sex desiring individuals frequently encounter and navigate competing understandings of sexuality and sexual identity. Western essentialist understanding of sexual identity introduced by international development partners and transnational LGBT+ (Lesbian, Gay, Bi- and Transsexual) activism, as well as media, offer an alternative to Ugandan non-essentialist and fluid subject positions. This article seeks to understand how young individuals with same-sex -desires in Kampala navigate tensions between Western and local understandings concerning sexuality. We have interviewed 24 young individuals with same-sex desires (unaffiliated and individuals working in LGBT+ organizations) and asked how they approach their sexuality and experiences living with same-sex desires in contemporary Kampala. The results reveal how interview participants engaged in a complex navigation between local community expectations, their own same-sex desires, and embeddedness in a global LGBT+ culture. Although the participants engaged in what Westerners would label as a "double life," the article problematizes the prescriptive norms of authenticity and "coming out." The conclusion is that the fluid vs essentialist dichotomy is too simplistic to be helpful when trying to understand the lives and aspirations of young people with same-sex desires.
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Affiliation(s)
- Jakob Svensson
- Department of Computer Science & Media Technology, Malmö University, Malmö, Sweden
| | - Cecilia Strand
- Department of Informatics & Media, Uppsala University, Uppsala, Sweden
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Nakitto M, Ssali RT, Johanningsmeier SD, Moyo M, de Kock H, Berget I, Okello JJ, Mayanja S, Tinyiro SE, Mendes T, Benard Y, Chelengat D, Osaru F, Bugaud C. Decision tree scoring system to guide selection for consumer preference in sweetpotato breeding trials. J Sci Food Agric 2024; 104:4615-4625. [PMID: 37490697 DOI: 10.1002/jsfa.12883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/30/2023] [Accepted: 07/26/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Previously, a lexicon and protocol for quantitative descriptive analysis (QDA) was established for the Uganda sweetpotato breeding program. The implication of QDA scores for priority sensory attributes on consumer preference should be determined to interpret results efficiently and make decisions effectively. The present study aimed to develop a gender-responsive decision tree to obtain an overall sweetpotato eating quality score to facilitate demand-led targeted breeding selection. It focused on Kamuli and Hoima districts (Uganda) and uses pre-lease advanced clones ('NKB3', 'NKB105', 'NKB135', 'D11' and 'D20'), released varieties ('NASPOT 8' and 'NAROSPOT 1') and landraces ('Muwulu-Aduduma', 'Umbrella'). RESULTS Including boiled sweetpotato sensory characteristics, namely mealy, sweet taste, sweetpotato smell, firm and not fibrous, in breeding design would benefit end-users, especially women given their role in varietal selection, food preparation and marketing. 'D20', 'NASPOT 8' and 'NAROSPOT 1' were most liked in both districts. 'NKB3' and 'D11' were the least liked in Hoima, whereas 'Muwulu-Aduduma' was the least liked in Kamuli. There was a positive correlation between color and overall liking (r2 = 0.8) and consumers liked the color (average rating ≥ 6 on a nine-point hedonic scale) of all genotypes. Threshold values (average rating on 11-point scales) for consumer acceptability were identified (sweet taste = 6, sweetpotato aroma and flavor = 6, firmness = 3, and mealiness = 4). A regression decision tree tool was created to calculate an eating quality selection index when screening lines in breeding programs using the values. CONCLUSION Decision trees that include consumer needs and gender considerations would facilitate demand-led breeding and make varietal selection in sweetpotato breeding programs more effective. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.
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Affiliation(s)
- Mariam Nakitto
- International Potato Center (CIP-SSA), Kampala, Uganda
- Department of Consumer and Food Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Suzanne D Johanningsmeier
- United States Department of Agriculture, Agricultural Research Service, Southeast Area, Food Science and Market Quality & Handling Research Unit, Raleigh, NC, USA
| | - Mukani Moyo
- International Potato Center (CIP-SSA Regional Office), Nairobi, Kenya
| | - Henriette de Kock
- Department of Consumer and Food Sciences, University of Pretoria, Pretoria, South Africa
| | - Ingunn Berget
- Norwegian Institute of Food, Fisheries and Aquaculture Research (NOFIMA), Tromsø, Norway
| | | | - Sarah Mayanja
- International Potato Center (CIP-SSA), Kampala, Uganda
| | - Samuel Edgar Tinyiro
- National Agricultural Research Laboratories, National Agricultural Research Organisation, Kampala, Uganda
| | - Thiago Mendes
- International Potato Center (CIP-SSA Regional Office), Nairobi, Kenya
| | - Yada Benard
- National Crops' Resources Research Institute, National Agricultural Research Organisation, Kampala, Uganda
| | - Doreen Chelengat
- National Crops' Resources Research Institute, National Agricultural Research Organisation, Kampala, Uganda
| | - Florence Osaru
- National Crops' Resources Research Institute, National Agricultural Research Organisation, Kampala, Uganda
| | - Christophe Bugaud
- CIRAD, UMR QUALISUD, Montpellier, France
- QualiSud, Univ Montpellier, CIRAD, Montpellier SupAgro, Univ Avigon, Univ La Réunion, Montpellier, France
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Maghembe RS, Magulye MAK, Eilu E, Sekyanzi S, Makaranga A, Mwesigwa S, Katagirya E. A sophisticated virulence repertoire and colistin resistance of Citrobacter freundii ST150 from a patient with sepsis admitted to ICU in a tertiary care hospital in Uganda, East Africa: Insight from genomic and molecular docking analyses. Infect Genet Evol 2024; 120:105591. [PMID: 38604286 PMCID: PMC11069293 DOI: 10.1016/j.meegid.2024.105591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
Sepsis and multidrug resistance comprise a complex of factors attributable to mortality among intensive care unit (ICU) patients globally. Pathogens implicated in sepsis are diverse, and their virulence and drug resistance remain elusive. From a tertiary care hospital ICU in Uganda, we isolated a Citrobacter freundii strain RSM030 from a patient with sepsis and phenotypically tested it against a panel of 16 antibiotics including imipenem levofloxacin, cotrimoxazole and colistin, among others. We sequenced the organism's genome and integrated multilocus sequencing (MLST), PathogenFinder with Virulence Factor analyzer (VFanalyzer) to establish its pathogenic relevance. Thereafter, we combined antiSMASH and PRISM genome mining with molecular docking to predict biosynthetic gene clusters (BGCs), pathways, toxin structures and their potential targets in-silico. Finally, we coupled ResFinder with comprehensive antibiotic resistance database (CARD) to scrutinize the genomic antimicrobial resistance profile of the isolate. From PathogenFinder and MLST, this organism was confirmed to be a human pathogen (p = 0.843), sequence type (ST)150, whose virulence is determined by chromosomal type III secretion system (T3SS) (the injectosome) and plasmid-encoded type IV secretion system (T4SS), the enterobactin biosynthetic gene cluster and biofilm formation through the pgaABCD operon. Pathway and molecular docking analyses revealed that the shikimate pathway can generate a toxin targeting multiple host proteins including spectrin, detector of cytokinesis protein 2 (Dock2) and plasmalemma vesicle-associated protein (PLVAP), potentially distorting the host cell integrity. From phenotypic antibiotic testing, we found indeterminate results for amoxicillin/clavulanate and levofloxacin, with resistance to cotrimoxazole and colistin. Detailed genome analysis revealed chromosomal beta lactam resistance genes, i.e. blaCMY-79, blaCMY-116 and blaTEM-1B, along with multiple mutations of the lipopolysaccharide modifying operon genes PmrA/PmrB, pmrD, mgrA/mgrB and PhoP/PhoQ, conferring colistin resistance. From these findings, we infer that Citrobacter freundii strain RSM030 is implicated in sepsis and resistance to standard antibiotics, including colistin, the last resort.
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Affiliation(s)
- Reuben S Maghembe
- Biological and Marine Sciences Unit, Faculty of Natural and Applied Sciences, Marian University College, P. O. Box 47, Bagamoyo, Tanzania; Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda; Department of Microbiology and Immunology, Faculty of Biomedical Sciences, Kampala International University, Wester Campus, Ishaka, Uganda.; Microbiology Section, Department of Biological Sciences, University of Botswana, Private Bag 0704, Gaborone, Botswana.
| | - Maximilian A K Magulye
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Emmanuel Eilu
- Department of Microbiology and Immunology, Faculty of Biomedical Sciences, Kampala International University, Wester Campus, Ishaka, Uganda
| | - Simon Sekyanzi
- Department of Medical Microbiology, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Abdalah Makaranga
- Biological and Marine Sciences Unit, Faculty of Natural and Applied Sciences, Marian University College, P. O. Box 47, Bagamoyo, Tanzania
| | - Savannah Mwesigwa
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Eric Katagirya
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
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Khakasa E, Muyanja C, Mugabi R, Bugaud C, Forestier-Chiron N, Uwimana B, Arinaitwe IK, Nowakunda K. Sensory characterization of the perceived quality of East African highland cooking bananas (matooke). J Sci Food Agric 2024; 104:4907-4914. [PMID: 37029474 DOI: 10.1002/jsfa.12606] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/12/2023] [Accepted: 04/08/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND It has recently become increasingly evident that banana projects in Uganda need to consider consumer preferences as part of the breeding process to increase the acceptability of new cultivars. A trained panel used quantitative descriptive analysis (QDA) as a tool to assess the sensory characteristics of 32 cooking bananas (matooke). The aim was to investigate which sensory characteristics best describe matooke. RESULTS Fourteen descriptors were generated. The preferred attributes of matooke were high-intensity yellow color, homogeneous distribution of yellow color, good matooke aroma, highly moldable by touch, moist and smooth in the mouth. Analysis of variance revealed significant differences in the yellowness, homogeneity of color, firmness, moistness, smoothness, matooke aroma, hardness, and moldability across the genotypes (P < 0.05). Principal component analysis (PCA) showed strong positive correlations between yellowness and homogeneity of the color (R = 0.92). Smoothness in the mouth and moldability by touch were strongly and positively correlated (R = 0.88). Firmness in the mouth was well predicted by hardness to touch (R2 = 0.85). The matooke samples were ranked into two sensory clusters by agglomerative hierarchical clustering (AHC). CONCLUSION The study showed attribute terms that could be used to describe matooke and also revealed that QDA may be used as a tool during the assessment and selection of new cooking banana hybrids to identify relevant sensory attributes because of its ability to discriminate among the banana hybrids. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.
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Affiliation(s)
- Elizabeth Khakasa
- National Agricultural Research Laboratories (NARL), Kampala, Uganda
- School of Food Technology Nutrition and Bioengineering, College of Agricultural and Environmental Sciences, Makerere University, Kampala, Uganda
| | - Charles Muyanja
- School of Food Technology Nutrition and Bioengineering, College of Agricultural and Environmental Sciences, Makerere University, Kampala, Uganda
| | - Robert Mugabi
- School of Food Technology Nutrition and Bioengineering, College of Agricultural and Environmental Sciences, Makerere University, Kampala, Uganda
| | - Christophe Bugaud
- CIRAD, UMR QUALISUD, Montpellier, France
- Qualisud, Univ Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La Réunion, Montpellier, France
| | - Nelly Forestier-Chiron
- CIRAD, UMR QUALISUD, Montpellier, France
- Qualisud, Univ Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La Réunion, Montpellier, France
| | - Brigitte Uwimana
- International Institute of Tropical Agriculture (IITA), Kampala, Uganda
| | | | - Kephas Nowakunda
- National Agricultural Research Laboratories (NARL), Kampala, Uganda
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Nantongo JS, Tinyiro SE, Nakitto M, Serunkuma E, Namugga P, Ayetigbo O, Mayanja S, Moyo M, Ssali R, Mendes T. End-user preferences to enhance prospects for varietal acceptance and adoption in potato breeding in Uganda. J Sci Food Agric 2024; 104:4606-4614. [PMID: 37550770 DOI: 10.1002/jsfa.12882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/29/2023] [Accepted: 08/08/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Potato varieties have diverse biophysical characteristics, so it is important for breeders to have the capacity to choose those that meet the preferences of end users, such as mealiness, firmness, and taste, among others. Combining user preferences with descriptive information regarding the sensory characteristics of boiled potatoes can contribute to the improvement of consumer-driven varieties. This study aimed to factor in the preferences of end users to improve the prospects for varietal acceptance, adoption, and discrimination among genotypes in potato breeding. RESULTS The priority quality traits (traits that play the most significant roles in acceptance and adoption) of the boiled potatoes were determined by evaluating gender and livelihood using the G+ tool. The G+ tool is designed to assess gender impact on roots, tubers and bananas (RTB) traits by serving as a validation check to reflect on important gender-based issues in agricultural food systems in order to reduce harm and promote positive impact. Potato genotypes were differentiated by penetration (textural parameters as measured by standard texture probe) and the procedure was repeatable, as there was no significant difference between the cooking replicates at 40 min of cooking. Instrument-based texture parameters, such as penetration peak force (hardness/firmness) and area (area under the curve, which represents energy needed to penetrate) of boiled potato tubers were significantly associated with sensory attributes such as fracturability and hardness in the mouth. An attempt to differentiate genotypes using near-infrared spectroscopy (NIRS) revealed that the average results observed for the calibration for yellow color (r2 = 0.70), homogeneity of color (r2 = 0.48), moisture in mass (r2 = 0.40), and uniformity of texture (r2 = 0.56) suggested that these parameters could be used for initial breeding screening purposes. CONCLUSIONS The preferred traits of the boiled potato can be integrated into the potato-breeding program/product profile. Near-infrared spectroscopy shows strong potential to predict potato color and the ability of NIRS models to predict some texture attributes is also promising. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.
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Affiliation(s)
| | | | | | | | - Prossy Namugga
- National Agriculture Research Laboratories, Kampala, Uganda
| | | | - Sarah Mayanja
- International Potato Center (CIP-SSA), Kampala, Uganda
| | - Mukani Moyo
- International Potato Center (CIP-SSA Regional Office), Nairobi, Kenya
| | - Reuben Ssali
- International Potato Center (CIP-SSA), Kampala, Uganda
| | - Thiago Mendes
- International Potato Center (CIP-SSA Regional Office), Nairobi, Kenya
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Nuwamanya E, Wembabazi E, Kanaabi M, Namakula FB, Katungisa A, Lyatumi I, Esuma W, Alamu EO, Dufour D, Kawuki R, Davrieux F. Development and validation of near-infrared spectroscopy procedures for prediction of cassava root dry matter and amylose contents in Ugandan cassava germplasm. J Sci Food Agric 2024; 104:4793-4800. [PMID: 37665950 DOI: 10.1002/jsfa.12966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/06/2023] [Accepted: 09/05/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Cassava utilization for food and/or industrial products depends on inherent properties of root dry matter content (DMC) and the starch fraction of amylose content (AC). Accordingly, in the present study, near-infrared reflectance spectroscopy (NIRS) models were developed to aid breeding and selection of DMC and AC as critical industrial traits taking care of root sample preparation and cassava germplasm diversity available in Uganda. RESULTS Upon undertaking calibrations and cross-validations, best models were adopted for validation. DMC in calibration samples ranged from 20 to 45 g 100g-1, whereas, for amylose content, it ranged from 14 to 33 g 100g-1. In the validation set, average DMC was 29.5 g 100g-1, whereas, for amylose content, it was 24.64 g 100g-1. For DMC, a modified partial least square regression model had regression coefficients (R2) of 0.98 and 0.96, respectively, in the calibration and validation set. These were also associated with low bias (-0.018) and ratio of performance deviation that ranged from 4.7 to 5.0. In addition, standard error of prediction values ranged from 0.9 g 100g-1 to 1.06 g 100g-1. For AC, the regression coefficient was 0.91 for the calibration set and 0.94 for the validation set. A bias equivalent to -0.03 and a ratio of performance deviation of 4.23 were observed. CONCLUSION These findings confirm the robustness of NIRS in the estimation of dry matter content and amylose content in cassava roots and thus justify its use in routine cassava breeding operations. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.
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Affiliation(s)
- Ephraim Nuwamanya
- National Crops Resources Research Institute, Kampala, Uganda
- Makerere University Kampala, Kampala, Uganda
| | - Enoch Wembabazi
- National Crops Resources Research Institute, Kampala, Uganda
| | - Michael Kanaabi
- National Crops Resources Research Institute, Kampala, Uganda
- Makerere University Kampala, Kampala, Uganda
| | | | | | - Ivan Lyatumi
- National Crops Resources Research Institute, Kampala, Uganda
| | - Williams Esuma
- National Crops Resources Research Institute, Kampala, Uganda
| | | | - Dominique Dufour
- UMR Qualisud, University of Montpellier, CIRAD, Montpellier SupAgro, University of Avignon, University of La Reunion, Montpellier, France
| | - Robert Kawuki
- National Crops Resources Research Institute, Kampala, Uganda
| | - Fabrice Davrieux
- UMR Qualisud, University of Montpellier, CIRAD, Montpellier SupAgro, University of Avignon, University of La Reunion, Montpellier, France
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9
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Nabunya P, Ssewamala FM, Kizito S, Mugisha J, Brathwaite R, Neilands TB, Migadde H, Namuwonge F, Ssentumbwe V, Najjuuko C, Sensoy Bahar O, Mwebembezi A, McKay MM. Preliminary Impact of Group-Based Interventions on Stigma, Mental Health, and Treatment Adherence Among Adolescents Living with Human Immunodeficiency Virus in Uganda. J Pediatr 2024; 269:113983. [PMID: 38401789 PMCID: PMC11095998 DOI: 10.1016/j.jpeds.2024.113983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/13/2024] [Accepted: 02/18/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE To examine the preliminary impact of group cognitive behavioral therapy and multiple family group-based family strengthening to address HIV stigma and improve the mental health functioning of adolescents living with HIV in Uganda. STUDY DESIGN We analyzed data from the Suubi4Stigma study, a 2-year pilot randomized clinical trial that recruited adolescents living with HIV (10-14 years) and their caregivers (n = 89 dyads), from 9 health clinics. We fitted separate three-level mixed-effects linear regression models to test the effect of the interventions on adolescent outcomes at 3 and 6 months post intervention initiation. RESULTS The average age was 12.2 years and 56% of participants were females. Participants in the multiple family group-based family strengthening intervention reported lower levels of internalized stigma (mean difference = -0.008, 95% CI = -0.015, -0.001, P = .025) and depressive symptoms at 3 months (mean difference = -0.34, 95% CI = -0.53, -0.14, P < .001), compared with usual care. On the other hand, participants in the group cognitive behavioral therapy intervention reported lower levels of anticipated stigma at 3 months (mean difference = -0.039, 95% CI = -0.072, -0.006), P = .013) and improved self-concept at 6 months follow-up (mean difference = 0.04, 95% CI = 0.01, 0.01, P = .025). CONCLUSION Outcome trends from this pilot study provide compelling evidence to support testing the efficacy of these group-based interventions on a larger scale. TRIAL REGISTRATION The study is registered in the Clinical trials.gov database (Identifier #: NCT04528732).
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO.
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO
| | - Samuel Kizito
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO
| | - James Mugisha
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rachel Brathwaite
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO
| | - Torsten B Neilands
- Division of Prevention Science, School of Medicine, University of California San Francisco, San Francisco, CA
| | - Herbert Migadde
- International Center for Child Health and Development (ICHAD) Field Office, Masaka, Uganda
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO
| | - Vicent Ssentumbwe
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO
| | - Claire Najjuuko
- Division of Computational & Data Sciences, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, MO
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, St. Louis, MO
| | | | - Mary M McKay
- Vice Provost Office, Washington University in St. Louis, St. Louis, MO
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Akankwasa K, Marimo P, Bouniol A, Tumuhimbise R, Asasira M, Kisakye S, Khakasa E, Tinyiro E, Mukasa Y, Tukashaba L, Namuddu MG, Ssenyonga PB, Dufour D, Tushemereirwe W, Nowakunda K. Analysis of association of sensory and laboratory assessments for quality and consumer acceptability of steamed East Africa highland bananas. J Sci Food Agric 2024; 104:4709-4721. [PMID: 37824735 DOI: 10.1002/jsfa.13043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The relevance of several characteristics for the acceptability of steamed East Africa bananas (matooke) was assessed using consumer-preferred characteristics, the overall liking scores, check-all-that-apply (CATA) and the Just About Right scale. The study was conducted in rural and urban locations in three banana growing regions of Uganda. Two landraces and two hybrids were processed into matooke. Twelve trained panellists evaluated color, taste and texture sensory characteristics. RESULTS Consumers scored matooke from landraces as the most liked. The CATA test showed that the most important characteristics were: smooth mouthfeel, soft to the touch, not sticky, moldable, deep yellow color, attractive, good matooke taste and smell. Principal component analysis confirmed that most of the preferred sensory characteristics were associated with the local genotypes, whereas the less preferred characteristics were associated with hybrids. Correlation analysis revealed strong positive correlations between the consumer assessed characteristics, hardness by touch, softness to touch and yellowness, as well as quantitative laboratory characteristics (moldable, hardness by touch, softness and yellowness) of the steamed matooke. Color assessed by consumers was strongly correlated with the laboratory-assessed color indicators. CONCLUSION The strong associations observed between laboratory-assessed and consumer-based characteristics (moldable by touch and yellowness) suggest the possibility of predicting consumer characteristics using quantitative laboratory sensory assessments. Matooke taste as assessed by consumer panel is strongly associated with smooth texture and deep yellow color, which were the characteristics associated with landraces in the laboratory sensory assessment. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.
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Affiliation(s)
- Kenneth Akankwasa
- National Agricultural Research Laboratories (NARL), Kampala, Uganda
- Rwebitaba Zonal Agricultural Research and Development Institute, Fort Portal, Uganda
| | - Pricilla Marimo
- Alliance of Bioversity International and International Centre for Tropical Agriculture - (CIAT), Kampala, Uganda
| | - Alexandre Bouniol
- Laboratoire de Sciences des Aliments, Faculté des Sciences Agronomiques, Université d'Abomey-Calavi, Jéricho, Benin
- CIRAD, UMR QUALISUD, Cotonou, Benin
| | - Robooni Tumuhimbise
- Rwebitaba Zonal Agricultural Research and Development Institute, Fort Portal, Uganda
| | - Moreen Asasira
- National Agricultural Research Laboratories (NARL), Kampala, Uganda
| | - Sarah Kisakye
- National Agricultural Research Laboratories (NARL), Kampala, Uganda
| | | | - Edgar Tinyiro
- National Agricultural Research Laboratories (NARL), Kampala, Uganda
| | - Yusuf Mukasa
- National Agricultural Research Laboratories (NARL), Kampala, Uganda
| | - Living Tukashaba
- National Agricultural Research Laboratories (NARL), Kampala, Uganda
| | - Mary G Namuddu
- National Agricultural Research Laboratories (NARL), Kampala, Uganda
| | - Peter B Ssenyonga
- Rwebitaba Zonal Agricultural Research and Development Institute, Fort Portal, Uganda
| | - Dominique Dufour
- CIRAD, UMR QualiSud, Montpellier, France
- QualiSud, Univ Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La Réunion, Montpellier, France
| | | | - Kephas Nowakunda
- National Agricultural Research Laboratories (NARL), Kampala, Uganda
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Oporia F, Jagnoor J, Mumbya J, Balugaba BE, Businge O, Agenonga J, Walekhwa AW, Isunju JB, Kobusingye O. Lifejackets or just jackets? Seaworthiness of lifejackets sold at landing sites of Lake Albert, Uganda. Int J Occup Saf Ergon 2024; 30:343-350. [PMID: 38148623 DOI: 10.1080/10803548.2023.2298147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Objectives. Upon immersion in water, a cascade of human physiological responses is evoked, which may result in drowning death. Although lifejackets are over 80% effective in preventing drowning, many people in lakeside fishing communities in Uganda shy away from wearing them because of active distrust in the quality of the lifejackets on the local market. No study has determined the veracity of these claims. This study determined the seaworthiness of lifejackets sold at landing sites of Lake Albert, Uganda. Methods. Using a within-person repeated assessment design, we tested 22 new lifejacket samples obtained from landing sites of Lake Albert, Uganda. We conducted water entry, righting, floatation stability and minimum buoyancy performance tests. Results. All the lifejacket samples failed the minimum buoyancy functional requirements test; the average buoyancy was 80 N (SD 13). Only 4% of the lifejackets passed the righting test within 5 s. For floatation stability, 45% of the lifejackets sank earlier than 48 h of placement in water and also failed water entry tests by getting dislodged from the wearer. Conclusion. The lifejackets sold at the landing sites of Lake Albert do not meet minimum seaworthiness functional requirements. The government should regulate the quality of lifejackets on the local market.
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Affiliation(s)
- Frederick Oporia
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Uganda
| | - Jagnoor Jagnoor
- The George Institute for Global Health, University of New South Wales, Australia
| | - Jonah Mumbya
- Maritime Administration, Ministry of Works and Transport, Uganda
| | - Bonny Enock Balugaba
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Uganda
| | - Otto Businge
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Uganda
| | - Jeff Agenonga
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Uganda
| | - Abel Wilson Walekhwa
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Uganda
| | - John Bosco Isunju
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Uganda
| | - Olive Kobusingye
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Uganda
- The George Institute for Global Health, University of New South Wales, Australia
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12
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Ocan M, Bakubi R, Nakalembe L, Ekusai-Sebatta D, Sam N. Experience of healthcare personnel on Co-payment mechanism and the implications on its use in private drug outlets in Uganda. PLoS One 2024; 19:e0297416. [PMID: 38758832 DOI: 10.1371/journal.pone.0297416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/16/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Malaria treatment is faced with the challenge of access, affordability, availability, and quality of antimalarial medicines. Affordable medicines facility-malaria (AMFm) program and subsequently Co-payment mechanism were developed to help increase access to quality assured Artemisinin-based combination therapies (ACTs) in seven countries in sub-Saharan Africa. We explored through a qualitative study, experience of healthcare personnel on Co-payment mechanism and the implication on its use in private drug outlets in Uganda. METHOD Private drug outlets that reported stocking antimalarial agents in moderate-to-high and low malaria transmission settings were purposively selected for inclusion in the study. In each drug outlet, data was collected from a pharmacist/dispenser through key informant interview. The interview was done using a key informant interview guide which covered the following areas, (i) sociodemographic characteristics, ii) awareness of healthcare personnel on the co-payment mechanism, (iii) awareness of healthcare personnel on quality assured artemisinin combination therapies (QAACT), (iv) antimalarial stocking in private drug outlets, (v) antimalarial dispensing prices, (vi) considerations made while stocking, and pricing antimalarial agents, vii) challenges in antimalarial dispensing, and (viii) access to antimalarial agents in private drug outlets. Data was managed using Atlas.ti and analyzed using framework methodology. RESULTS Data was collected from 25 key informants (12 pharmacists and 13 dispensers). Five themes emerged following data analysis, (i) antimalarial stocking influenced by price and client demand, (ii) access and purchasing behavior of drug outlet clients, (iii) basis of dispensing antimalarial agents in private drug outlets, (iv) awareness of QAACT, and (v) awareness of Co-payment mechanism. None of the study participants was aware of the existence of Co-payment mechanism and QAACT in the private sector. Duocotecin brand of ACTs was the most mentioned and dispensed ACT among the study participants in private drug outlets. Nearly all the pharmacists/dispensers said that many clients who request to purchase ACTs don't come with a prescription and prefer buying cheaper antimalarial agents. Study participants reported stocking and selling both ACTs and non-ACT antimalarial agents in the drug outlets. Pharmacists/dispensers in the drug outlets reported that most clients could not afford buying a full dose of an ACT. None of the study participants considered using Co-payment mechanism while stocking ACTs in the drug outlets. CONCLUSION There is lack of awareness and utilization of Co-payment mechanism in stocking, pricing, and dispensing of ACTs among pharmacists/dispensers in private drug outlets in Uganda. The antimalarial dispensing in drug outlets was mostly based on prescriptions, clients' preferences, and medicine affordability. The Ministry of Health needs to create demand for Co-payment mechanism through public awareness campaigns, training of healthcare personnel and behavior change communication in the private sector.
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Affiliation(s)
- Moses Ocan
- Department of Pharmacology & Therapeutics, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Racheal Bakubi
- Department of Health Policy, Planning and Management, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Loyce Nakalembe
- Department of Pharmacology, Soroti University, Soroti, Uganda
| | | | - Nsobya Sam
- Infectious Disease Research Collaboration (IDRC), Kampala, Uganda
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Ssali A, Namugumya R, Nalubega P, Kyohere M, Seeley J, Doare KL. Exploring the consent process among pregnant and breastfeeding women taking part in a maternal vaccine clinical trial in Kampala, Uganda: a qualitative study. BMC Med Ethics 2024; 25:57. [PMID: 38755578 PMCID: PMC11097482 DOI: 10.1186/s12910-024-01055-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The involvement of pregnant women in vaccine clinical trials presents unique challenges for the informed consent process. We explored the expectations and experiences of the pregnant women, spouses/partners, health workers and stakeholders of the consent process during a Group B Streptococcus maternal vaccine trial. METHODS We interviewed 56 participants including pregnant women taking part in the trial, women not in the trial, health workers handling the trial procedures, spouses, and community stakeholders. We conducted 13 in-depth interviews and focus group discussions with 23 women in the trial, in-depth interviews with 5 spouses, and 5 women not in the trial, key informant interviews with 5 health workers and 5 other stakeholders were undertaken. RESULTS Decision-making by a pregnant woman to join a trial was done in consultation with spouse, parents, siblings, or trusted health workers. Written study information was appreciated by all but they suggested the use of audio and visual presentation to enhance understanding. Women stressed the need to ensure that their male partners received study information before their pregnant partners joined a clinical trial. Confidentiality in research was emphasised differently by individual participants; while some emphasised it for self, others were keen to protect their family members from being exposed, for allowing them to be involved in research. However, others wanted their community participation to be acknowledged. CONCLUSION We found that pregnant women make decisions to join a clinical trial after consulting with close family. Our findings suggest the need for an information strategy which informs not only the pregnant woman, but also her family about the research she is invited to engage in.
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Affiliation(s)
- Agnes Ssali
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.
| | - Rita Namugumya
- Makerere University -John Hopkins University Research Collaboration, Kampala, Uganda
| | - Phiona Nalubega
- Makerere University -John Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK
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Mulogo E, Ntaro M, Wesuta A, Namusisi J, Kawungezi P, Batwala V, Matte M. Cost-effectiveness of village health worker-led integrated community case management (iCCM) versus health facility based management for childhood illnesses in rural southwestern Uganda. Malar J 2024; 23:147. [PMID: 38750488 PMCID: PMC11097548 DOI: 10.1186/s12936-024-04962-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/24/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND In Uganda, village health workers (VHWs) manage childhood illness under the integrated community case management (iCCM) strategy. Care is provided for malaria, pneumonia, and diarrhoea in a community setting. Currently, there is limited evidence on the cost-effectiveness of iCCM in comparison to health facility-based management for childhood illnesses. This study examined the cost-effectiveness of the management of childhood illness using the VHW-led iCCM against health facility-based services in rural south-western Uganda. METHODS Data on the costs and effectiveness of VHW-led iCCM versus health facility-based services for the management of childhood illness was collected in one sub-county in rural southwestern Uganda. Costing was performed using the ingredients approach. Effectiveness was measured as the number of under-five children appropriately treated. The Incremental Cost-Effectiveness Ratio (ICER) was calculated from the provider perspective. RESULTS Based on the decision model for this study, the cost for 100 children treated was US$628.27 under the VHW led iCCM and US$87.19 for the health facility based services, while the effectiveness was 77 and 71 children treated for VHW led iCCM and health facility-based services, respectively. An ICER of US$6.67 per under five-year child treated appropriately for malaria, pneumonia and diarrhoea was derived for the provider perspective. CONCLUSION The health facility based services are less costly when compared to the VHW led iCCM per child treated appropriately. The VHW led iCCM was however more effective with regard to the number of children treated appropriately for malaria, pneumonia and diarrhoea. Considering the public health expenditure per capita for Uganda as the willingness to pay threshold, VHW led iCCM is a cost-effective strategy. VHW led iCCM should, therefore, be enhanced and sustained as an option to complement the health facility-based services for treatment of childhood illness in rural contexts.
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Affiliation(s)
- Edgar Mulogo
- Department of Community Health, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda.
| | - Moses Ntaro
- Department of Community Health, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda
| | - Andrew Wesuta
- Bugoye Community Health Collaboration, P.O. Box 149, Kasese, Uganda
| | - Jane Namusisi
- Department of Pediatrics, Mbarara Regional Referral Hospital, P.O. Box 40, Mbarara, Uganda
| | - Peter Kawungezi
- Department of Community Health, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda
| | - Vincent Batwala
- Department of Community Health, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda
- Directorate of Research and Graduate Training, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Michael Matte
- Bugoye Community Health Collaboration, P.O. Box 149, Kasese, Uganda
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Steadman A, Andama A, Ball A, Mukwatamundu J, Khimani K, Mochizuki T, Asege L, Bukirwa A, Kato JB, Katumba D, Kisakye E, Mangeni W, Mwebe S, Nakaye M, Nassuna I, Nyawere J, Nakaweesa A, Cook C, Phillips P, Nalugwa T, Bachman CM, Semitala FC, Weigl BH, Connelly J, Worodria W, Cattamanchi A. New Manual Quantitative Polymerase Chain Reaction Assay Validated on Tongue Swabs Collected and Processed in Uganda Shows Sensitivity That Rivals Sputum-based Molecular Tuberculosis Diagnostics. Clin Infect Dis 2024; 78:1313-1320. [PMID: 38306491 DOI: 10.1093/cid/ciae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/06/2023] [Accepted: 01/26/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Sputum-based testing is a barrier to increasing access to molecular diagnostics for tuberculosis (TB). Many people with TB are unable to produce sputum, and sputum processing increases assay complexity and cost. Tongue swabs are emerging as an alternative to sputum, but performance limits are uncertain. METHODS From June 2022 to July 2023, we enrolled 397 consecutive adults with cough >2 weeks at 2 health centers in Kampala, Uganda. We collected demographic and clinical information, sputum for TB testing (Xpert MTB/RIF Ultra and 2 liquid cultures), and tongue swabs for same-day quantitative polymerase chain reaction (qPCR) testing. We evaluated tongue swab qPCR diagnostic accuracy versus sputum TB test results, quantified TB targets per swab, assessed the impact of serial swabbing, and compared 2 swab types (Copan FLOQSWAB and Steripack spun polyester). RESULTS Among 397 participants, 43.1% were female, median age was 33 years, 23.5% were diagnosed with human immunodeficiency virus, and 32.0% had confirmed TB. Sputum Xpert Ultra and tongue swab qPCR results were concordant for 98.2% (95% confidence interval [CI]: 96.2-99.1) of participants. Tongue swab qPCR sensitivity was 92.6% (95% CI: 86.5 to 96.0) and specificity was 99.1% (95% CI: 96.9 to 99.8) versus microbiological reference standard. A single tongue swab recovered a 7-log range of TB copies, with a decreasing recovery trend among 4 serial swabs. Swab types performed equivalently. CONCLUSIONS Tongue swabs are a promising alternative to sputum for molecular diagnosis of TB, with sensitivity approaching sputum-based molecular tests. Our results provide valuable insights for developing successful tongue swab-based TB diagnostics.
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Affiliation(s)
- Amy Steadman
- Global Health Labs, Inc, Bellevue, Washington, USA
| | - Alfred Andama
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Walimu, Kampala, Uganda
| | - Alexey Ball
- Global Health Labs, Inc, Bellevue, Washington, USA
| | | | | | - Tessa Mochizuki
- Center for Tuberculosis, University of California-San Francisco, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Catherine Cook
- Center for Tuberculosis, University of California-San Francisco, San Francisco, California, USA
| | - Patrick Phillips
- Center for Tuberculosis, University of California-San Francisco, San Francisco, California, USA
| | | | | | - Fred Collins Semitala
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - William Worodria
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Adithya Cattamanchi
- Division of Pulmonary Diseases and Critical Care Medicine, University of California-Irvine, Irvine, California, USA
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Petitt Z, Trillo Ordonez Y, Agwu C, Ott M, Shakir M, Ayala Mullikin A, Davis J, Khalafallah AM, Tang A, Shalita C, Ssembatya JM, Deng DD, Headley J, Obiga O, Haglund MM, Fuller AT. Exploring the feasibility of pupillometry training and perceptions of potential use for intracranial pressure monitoring in Uganda: A mixed methods study. PLoS One 2024; 19:e0298619. [PMID: 38748676 PMCID: PMC11095748 DOI: 10.1371/journal.pone.0298619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 01/26/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) accounts for the majority of Uganda's neurosurgical disease burden; however, invasive intracranial pressure (ICP) monitoring is infrequently used. Noninvasive monitoring could change the care of patients in such a setting through quick detection of elevated ICP. PURPOSE Given the novelty of pupillometry in Uganda, this mixed methods study assessed the feasibility of pupillometry for noninvasive ICP monitoring for patients with TBI. METHODS Twenty-two healthcare workers in Kampala, Uganda received education on pupillometry, practiced using the device on healthy volunteers, and completed interviews discussing pupillometry and its implementation. Interviews were assessed with qualitative analysis, while quantitative analysis evaluated learning time, measurement time, and accuracy of measurements by participants compared to a trainer's measurements. RESULTS Most participants (79%) reported a positive perception of pupillometry. Participants described the value of pupillometry in the care of patients during examination, monitoring, and intervention delivery. Commonly discussed concerns included pupillometry's cost, understanding, and maintenance needs. Perceived implementation challenges included device availability and contraindications for use. Participants suggested offering continued education and engaging hospital leadership as implementation strategies. During training, the average learning time was 13.5 minutes (IQR 3.5), and the measurement time was 50.6 seconds (IQR 11.8). Paired t-tests to evaluate accuracy showed no statistically significant difference in comparison measurements. CONCLUSION Pupillometry was considered acceptable for noninvasive ICP monitoring of patients with TBI, and pupillometer use was shown to be feasible during training. However, key concerns would need to be addressed during implementation to aid device utilization.
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Affiliation(s)
- Zoey Petitt
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
- Duke University Global Health Institute, Durham, NC, United States of America
| | - Yesel Trillo Ordonez
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
| | - Chibueze Agwu
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Pritzker School of Medicine, The University of Chicago Medical Center, Chicago, IL, United States of America
| | - Maura Ott
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
| | - Muhammad Shakir
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Aga Khan University Hospital, Karachi, Pakistan
| | - Alexandria Ayala Mullikin
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
| | - Jenna Davis
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Adham M. Khalafallah
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Department of Neurosurgery, University of Miami, Miami, FL, United States of America
| | - Alan Tang
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
| | - Chidyaonga Shalita
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
| | - Joseph Mary Ssembatya
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Division of Neurosurgery, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Di D. Deng
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
| | - Jennifer Headley
- Duke University Global Health Institute, Durham, NC, United States of America
| | - Oscar Obiga
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda
| | - Michael M. Haglund
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
- Duke University Global Health Institute, Durham, NC, United States of America
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, United States of America
| | - Anthony T. Fuller
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
- Duke University Global Health Institute, Durham, NC, United States of America
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, United States of America
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Gausi K, Mugerwa H, Siccardi M, Montanha MC, Lamorde M, Wiesner L, D’Avolio A, McIlleron H, Wilkins E, De Nicolò A, Maartens G, Khoo S, Kityo C, Denti P, Waitt C. Pharmacokinetics and Safety of Twice-daily Ritonavir-boosted Atazanavir With Rifampicin. Clin Infect Dis 2024; 78:1246-1255. [PMID: 37982585 PMCID: PMC11093668 DOI: 10.1093/cid/ciad700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Critical drug-drug interactions (DDI) and hepatotoxicity complicate concurrent use of rifampicin and protease inhibitors. We investigated whether dose escalation of atazanavir/ritonavir could safely overcome the DDI with rifampicin. METHODS DERIVE (NCT04121195, EDCTP) was a dose-escalation trial in people with human immunodeficiency virus (HIV) on atazanavir/ritonavir-based antiretroviral therapy (ART) in Uganda. Four intensive pharmacokinetic (PK) visits were performed: PK1 300/100 mg OD (baseline); PK2 300/100 mg OD with rifampicin 600 mg; PK3 300/100 mg twice a day (BID) with rifampicin 600 mg OD; PK4 300/100 mg BID with rifampicin 1200 mg OD. Dolutegravir 50 mg BID throughout the study period ensured participants remained protected from subtherapeutic atazanavir concentrations. The data were interpreted with noncompartmental analysis. The target minimum concentration was atazanavir's protein-adjusted IC90 (PA-IC90), 0.014 mg/L. RESULTS We enrolled 26 participants (23 female) with median (range) age 44 (28-61) years and weight 67 (50-75) kg. Compared with PK1, atazanavir Ctau, and AUC were significantly reduced at PK2 by 96% and 85%, respectively. The escalation to BID dosing (PK3) reduced this difference in Ctau, and AUC24 to 18% lower and 8% higher, respectively. Comparable exposures were maintained with double doses of rifampicin. Lowest Ctau during PK1, PK3, and PK4 were 12.7-, 4.8-, and 8.6-fold higher than PA-IC90, respectively, whereas 65% of PK2 Ctau were below the limit of quantification (0.03 mg/L), hence likely below PA-IC90. No participant developed significant elevation of liver enzymes, reported a serious adverse event (SAE) or experienced rebound viraemia. CONCLUSIONS Twice daily atazanavir/ritonavir during rifampicin co-administration was well tolerated and achieved plasma concentrations above the target. CLINICAL TRIALS REGISTRATION NCT04121195. Registered on 09 October 2019, https://clinicaltrials.gov/ct2/show/NCT04121195.
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Affiliation(s)
- Kamunkhwala Gausi
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Henry Mugerwa
- Joint Clinical Research Centre, Research Department, Kampala, Uganda
| | - Marco Siccardi
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Maiara Camotti Montanha
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Antonio D’Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Edmund Wilkins
- North Manchester General Hospital, HIV Research Unit, Manchester, United Kingdom
| | - Amedeo De Nicolò
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Saye Khoo
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Cissy Kityo
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Catriona Waitt
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
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Bebell LM, Ngonzi J, Butler A, Kumbakumba E, Adong J, Loos C, Boatin AA, Bassett IV, Siedner MJ, Williams PL, Mattie H, Hedt-Gauthier B, Correia KFB, Lake E, Alter G. Distinct cytokine profiles in late pregnancy in Ugandan people with HIV. Sci Rep 2024; 14:10980. [PMID: 38744864 PMCID: PMC11093984 DOI: 10.1038/s41598-024-61764-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/09/2024] [Indexed: 05/16/2024] Open
Abstract
During pregnancy, multiple immune regulatory mechanisms establish an immune-tolerant environment for the allogeneic fetus, including cellular signals called cytokines that modify immune responses. However, the impact of maternal HIV infection on these responses is incompletely characterized. We analyzed paired maternal and umbilical cord plasma collected during labor from 147 people with HIV taking antiretroviral therapy and 142 HIV-uninfected comparators. Though cytokine concentrations were overall similar between groups, using Partial Least Squares Discriminant Analysis we identified distinct cytokine profiles in each group, driven by higher IL-5 and lower IL-8 and MIP-1α levels in pregnant people with HIV and higher RANTES and E-selectin in HIV-unexposed umbilical cord plasma (P-value < 0.01). Furthermore, maternal RANTES, SDF-α, gro α -KC, IL-6, and IP-10 levels differed significantly by HIV serostatus (P < 0.01). Although global maternal and umbilical cord cytokine profiles differed significantly (P < 0.01), umbilical cord plasma profiles were similar by maternal HIV serostatus. We demonstrate that HIV infection is associated with a distinct maternal plasma cytokine profile which is not transferred across the placenta, indicating a placental role in coordinating local inflammatory response. Furthermore, maternal cytokine profiles in people with HIV suggest an incomplete shift from Th2 to Th1 immune phenotype at the end of pregnancy.
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Affiliation(s)
- Lisa M Bebell
- Medical Practice Evaluation Center and Center for Global Health, Massachusetts General Hospital Division of Infectious Diseases, GRJ-504, 55 Fruit St, Boston, MA, 02114, USA.
| | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Audrey Butler
- State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Elias Kumbakumba
- Department of Paediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Julian Adong
- Department of Paediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Carolin Loos
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Adeline A Boatin
- Department of Obstetrics and Gynecology and Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Ingrid V Bassett
- Division of Infectious Diseases and Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Mark J Siedner
- Division of Infectious Diseases and Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Paige L Williams
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Heather Mattie
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bethany Hedt-Gauthier
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Erin Lake
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
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Kananura RM, Birabwa C, Ssanyu JN, Kizito F, Kagaha A, Namutanba S, Kyangwa M, Kakaire O, Waiswa P. Increasing coverage and uptake of voluntary family planning in Uganda's emerging municipalities and secondary cities: An implementation research study protocol. PLoS One 2024; 19:e0293351. [PMID: 38728317 PMCID: PMC11086862 DOI: 10.1371/journal.pone.0293351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/26/2023] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION While urban areas are often perceived to have better access to healthcare services, including modern family planning (FP) services, urban dwellers including those with better socioeconomic status are faced with multidimensional challenges that shape their access to appropriate FP services. In Uganda's urban spaces, there is currently a lack of understanding among service providers, civil society organizations, and individuals/communities regarding the implementation of interventions that promote informed choice and voluntary use of family planning services. This knowledge gap has profound implications for reproductive rights. This study seeks to enhance existing efforts towards increasing coverage and uptake of Voluntary Family Planning (VFP) in Jinja City and Iganga Municipality, central eastern Uganda. Our primary question is, "What interventions can effectively be packaged and delivered to increase the uptake of VFP among different segments of urban residents?" METHODS We propose to use the Human-Centered Design (HCD) approach to understand the needs and challenges of users and community capabilities in ensuring access to VFP services. Co-creating with stakeholders' engagement and a data-driven-centric approach will steer design and adaptation that respond to the different population segments within the urban space. As such, the study will be implemented in three phases: formative assessment, design and implementation, and implementation monitoring and evaluation. The implementation process will incorporate robust monitoring, learning, and adaptation mechanisms. The primary focus of these mechanisms will be to utilize gathered information effectively to inform the design of the implementation and facilitate continuous learning throughout the process. The study will apply a process monitoring and evaluation approach to address questions related to what package of FP interventions work, for whom, under what circumstances and why. DISCUSSION Guided by strong learning and implementation flexibility, we hypothesize that our implementation will provide segmentation-specific high-impact interventions in an urban context. REGISTRATION This implementation research protocol has been registered on the Open Science Framework (OSF) repository Registries (https://osf.io/vqxu9; DOI: 10.17605/OSF.IO/VQXU9).
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Affiliation(s)
- Rornald Muhumuza Kananura
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Center of Excellence for Maternal, Newborn and Child Health, Makerere University School of Public Health, Kampala, Uganda
- Advance Innovations for Transforming Health in Africa, Kampala, Uganda
- African Population and Health Research Center, Nairobi, Kenya
| | - Catherine Birabwa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Jacquellyn Nambi Ssanyu
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | | | - Alexander Kagaha
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Othman Kakaire
- Department of Obstetrics and Gynecology, Makerere University School of Medicine, College of Health Sciences, Kampala, Uganda
| | - Peter Waiswa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Center of Excellence for Maternal, Newborn and Child Health, Makerere University School of Public Health, Kampala, Uganda
- Advance Innovations for Transforming Health in Africa, Kampala, Uganda
- Busoga Health Forum, Jinja, Uganda
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Nono D, Mwebesa E, Bagenda G, Okullo I, Rwenyonyi CM, Williams S. Assessment of the knowledge, attitude and practices of the informed consent process in oral healthcare among dental students in Makerere University Dental Hospital, Uganda. BMC Med Educ 2024; 24:516. [PMID: 38730378 PMCID: PMC11084059 DOI: 10.1186/s12909-024-05520-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/06/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION Informed consent is an ethical and legal component of healthcare. It ensures patient autonomy and allows patients to make decisions regarding their treatment. In dental care, informed consent is particularly important because most dental procedures are invasive. Since dental students are future dentists, they need to learn about their ethical obligations and accountability through the informed consent process as this is critical to patients' well-being. This study aimed to determine dental students' knowledge, attitudes, and practices of the informed consent process for oral health care in Makerere University Dental Hospital, Uganda. STUDY METHODOLOGY This was a descriptive cross-sectional study using quantitative methods. It was carried out at Makerere University Dental Hospital and third, fourth, and fifth-year students (n = 102) pursuing a Bachelor of Dental Surgery program took part in the survey. A self-administered structured questionnaire was used to assess their knowledge, attitudes, and practices of informed consent for oral health care. Collected data were entered into Epi-data version 3.1, where it was cleaned, coded, and imported to STATA version 14 software for statistical analysis. RESULTS About two-thirds 67 (65.7%) of the participants were males. The mean age was 25 (SD = 3.21) years. The majority (90%) of the students had a high level of knowledge of the informed consent process. About (80%) had a positive attitude towards informed consent and (85%) most often practiced the informed consent process. Based on bi-variate analysis, training on informed consent, year of study, age, and sex were significantly associated with the informed consent process. However, there was no significant risk factor associated with informed consent in multiple logistic regression analysis. CONCLUSION The study findings highlighted high levels of knowledge, positive attitude, and practice of the informed consent process among the clinical dental students. Continuous training is necessary to remind dental students about the importance of informed consent in healthcare, not only for complex procedures.
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Affiliation(s)
- David Nono
- Faculty of Life Sciences and Education, University of South Wales, Cardiff, UK.
- Learna Ltd Ty Bevan, House Cleeve Drive LIanishen, Cardiff, CF14 5GF, UK.
- School of Dentistry, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Ernest Mwebesa
- School of Dentistry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Godfrey Bagenda
- School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Isaac Okullo
- School of Dentistry, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Simon Williams
- Learna Ltd Ty Bevan, House Cleeve Drive LIanishen, Cardiff, CF14 5GF, UK
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Musanje K, Kasujja R, Camlin CS, Hooper N, Hope-Bell J, Sinclair DL, Kibanja GM, Mpirirwe R, Kalyango JN, Kamya MR. Effectiveness of a mindfulness and acceptance-based intervention for improving the mental health of adolescents with HIV in Uganda: An open-label trial. PLoS One 2024; 19:e0301988. [PMID: 38722926 PMCID: PMC11081388 DOI: 10.1371/journal.pone.0301988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/20/2024] [Indexed: 05/13/2024] Open
Abstract
Adolescents with HIV (AWH) face the double burden of dealing with challenges presented by their developmental phase while coping with stigma related to HIV, affecting their mental health. Poor mental health complicates adherence to daily treatment regimens, requiring innovative psychosocial support strategies for use with adolescents. We assessed the effectiveness of a mindfulness and acceptance-based intervention on the mental health of AWH in Uganda. One hundred and twenty-two AWH, mean age 17 ±1.59 (range 15 to 19 years), 57% female, receiving care at a public health facility in Kampala were enrolled in an open-label randomized trial (ClinicalTrials.gov: NCT05010317) with assessments at pre-and post-intervention. The mindfulness and acceptance-based intervention involved weekly 90-minute group sessions for four consecutive weeks facilitated by two experienced trainers. Sessions involved clarifying values, skillfully relating to thoughts, allowing and becoming aware of experiences non-judgmentally, and exploring life through trial and error. The control group received the current standard of care. Three mental health domains (depression, anxiety, and internalized stigma) were compared between the intervention and control groups. A linear mixed effects regression was used to analyze the effect of the intervention across the two time points. Results showed that the intervention was associated with a statistically significant reduction in symptoms of depression (β = -10.72, 95%CI: 6.25, -15.20; p < .0001), anxiety (β = -7.55, 95%CI: 2.66, -12.43; p = .0003) and stigma (β = -1.40, 95%CI: 0.66 to -2.15; p = .0004) over time. Results suggest that mindfulness and acceptance-based interventions have the potential to improve the mental health of AWH.
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Affiliation(s)
- Khamisi Musanje
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
- School of Psychology, Makerere University, Kampala, Uganda
| | - Rosco Kasujja
- School of Psychology, Makerere University, Kampala, Uganda
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, United States of America
| | - Nic Hooper
- School of Psychology, Cardiff University, Wales, United Kingdom
| | - Josh Hope-Bell
- School of Medicine, Cardiff University, Wales, United Kingdom
| | | | | | - Ruth Mpirirwe
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - Joan N. Kalyango
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - Moses R. Kamya
- School of Medicine, Makerere University, Kampala, Uganda
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Gwokyalya R, Nanteza A, Wagaba H, Kayondo SI, Kazigaba D, Nakabonge G. Morphological and genetic characterization of jackfruit (Artocarpus heterophyllus) in the Kayunga and Luwero districts of Uganda. BMC Plant Biol 2024; 24:355. [PMID: 38724929 PMCID: PMC11080175 DOI: 10.1186/s12870-024-05064-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/25/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Jackfruit (Artocarpus heterophyllus) is an economically valuable fruit tree in Uganda. However, the production of jackfruit in Uganda is low. Additionally, because of deforestation, genetic erosion of the resource is predicted before its exploitation for crop improvement and conservation. As a prerequisite for crop improvement and conservation, 100 A. heterophyllus tree isolates from the Kayunga and Luwero districts in Uganda were characterized using 16 morphological and 10 microsatellite markers. RESULTS The results from the morphological analysis revealed variations in tree height, diameter at breast height (DBH), and crown diameter, with coefficient of variation (CV) values of 20%, 41%, and 33%, respectively. Apart from the pulp taste, variation was also observed in qualitative traits, including tree vigor, trunk surface, branching density, tree growth habit, crown shape, leaf blade shape, fruit shape, fruit surface, flake shape, flake color, flake flavor and pulp consistency/texture. Genotyping revealed that the number of alleles amplified per microsatellite locus ranged from 2 to 5, with an average of 2.90 and a total of 29. The mean observed (Ho) and expected (He) heterozygosity were 0.71 and 0.57, respectively. Analysis of molecular variance (AMOVA) indicated that 81% of the variation occurred within individual trees, 19% among trees within populations and 0% between the two populations. The gene flow (Nm) in the two populations was 88.72. The results from the 'partitioning around medoids' (PAM), principal coordinate analysis (PCoA) and genetic cluster analysis further revealed no differentiation of the jackfruit populations. The Mantel test revealed a negligible correlation between the morphological and genetic distances. CONCLUSIONS Both morphological and genetic analyses revealed variation in jackfruit within a single interbreeding population. This diversity can be exploited to establish breeding and conservation strategies to increase the production of jackfruit and hence boost farmers' incomes. However, selecting germplasm based on morphology alone may be misleading.
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Affiliation(s)
- Racheal Gwokyalya
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. Box 7062, Kampala, Uganda
- National Crops Resources Research Institute, National Agricultural Research Organization, P.O. Box 7084, Kampala, Uganda
| | - Ann Nanteza
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Henry Wagaba
- National Crops Resources Research Institute, National Agricultural Research Organization, P.O. Box 7084, Kampala, Uganda
| | - Siraj Ismail Kayondo
- International Institute of Tropical Agriculture, Eastern African Hub, P.O. Box 34441, Dar es Salaam, Tanzania
| | - Dan Kazigaba
- National Forestry Resources Research Institute, National Agricultural Research Organization, P.O. Box 1752, Kampala, Uganda
| | - Grace Nakabonge
- College of Agricultural and Environmental Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda.
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Cross DL, Layton ED, Yu KK, Smith MT, Aguilar MS, Li S, Wilcox EC, Chapuis AG, Mayanja-Kizza H, Stein CM, Boom WH, Hawn TR, Bradley P, Newell EW, Seshadri C. MR1-restricted T cell clonotypes are associated with "resistance" to Mycobacterium tuberculosis infection. JCI Insight 2024; 9:e166505. [PMID: 38716731 DOI: 10.1172/jci.insight.166505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/27/2024] [Indexed: 05/14/2024] Open
Abstract
T cells are required for protective immunity against Mycobacterium tuberculosis. We recently described a cohort of Ugandan household contacts of tuberculosis cases who appear to "resist" M. tuberculosis infection (resisters; RSTRs) and showed that these individuals harbor IFN-γ-independent T cell responses to M. tuberculosis-specific peptide antigens. However, T cells also recognize nonprotein antigens via antigen-presenting systems that are independent of genetic background, known as donor-unrestricted T cells (DURTs). We used tetramer staining and flow cytometry to characterize the association between DURTs and "resistance" to M. tuberculosis infection. Peripheral blood frequencies of most DURT subsets were comparable between RSTRs and latently infected controls (LTBIs). However, we observed a 1.65-fold increase in frequency of MR1-restricted T (MR1T) cells among RSTRs in comparison with LTBIs. Single-cell RNA sequencing of 18,251 MR1T cells sorted from 8 donors revealed 5,150 clonotypes that expressed a common transcriptional program, the majority of which were private. Sequencing of the T cell receptor α/T cell receptor δ (TCRα/δ) repertoire revealed several DURT clonotypes were expanded among RSTRs, including 2 MR1T clonotypes that recognized mycobacteria-infected cells in a TCR-dependent manner. Overall, our data reveal unexpected donor-specific diversity in the TCR repertoire of human MR1T cells as well as associations between mycobacteria-reactive MR1T clonotypes and resistance to M. tuberculosis infection.
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Affiliation(s)
- Deborah L Cross
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Erik D Layton
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Krystle Kq Yu
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Malisa T Smith
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Melissa S Aguilar
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Shamin Li
- Vaccine and Infectious Disease Division and
| | - Elise C Wilcox
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Aude G Chapuis
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | | | - Catherine M Stein
- Department of Medicine and
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Thomas R Hawn
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Philip Bradley
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | | | - Chetan Seshadri
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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Nampijja D, Kyoyagala S, Najjingo E, Najjuma JN, Byamukama O, Kyasimire L, Kabakyenga J, Kumbakumba E. Newborn care knowledge and practices among care givers of newborns and young infants attending a regional referral hospital in Southwestern Uganda. PLoS One 2024; 19:e0292766. [PMID: 38713705 DOI: 10.1371/journal.pone.0292766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/19/2024] [Indexed: 05/09/2024] Open
Abstract
A child born in developing countries has a 10 times higher mortality risk compared to one born in developed countries. Uganda still struggles with a high neonatal mortality rate at 27/1000 live births. Majority of these death occur in the community when children are under the sole care of their parents and guardian. Lack of knowledge in new born care, inappropriate new born care practices are some of the contributors to neonatal mortality in Uganda. Little is known about parent/caregivers' knowledge, practices and what influences these practices while caring for the newborns. We systematically studied and documented newborn care knowledge, practices and associated factors among parents and care givers. To assess new born care knowledge, practices and associated factors among parents and care givers attending MRRH. We carried out a quantitative cross section methods study among caregivers of children from birth to six weeks of life attending a regional referral hospital in south western Uganda. Using pretested structured questionnaires, data was collected about care givers' new born care knowledge, practices and the associated factors. Data analysis was done using Stata version 17.0. We interviewed 370 caregivers, majority of whom were the biological mothers at 86%. Mean age was 26 years, 14% were unemployed and 74% had monthly earning below the poverty line. Mothers had a high antenatal care attendance of 97.6% and 96.2% of the deliveries were at a health facility Care givers had variant knowledge of essential newborn care with associated incorrect practices. Majority (84.6%) of the respondents reported obliviousness to putting anything in the babies' eyes at birth, however, breastmilk, water and saliva were reportedly put in the babies' eyes at birth by some caregivers. Hand washing was not practiced at all in 16.2% of the caregivers before handling the newborn. About 7.4% of the new borns received a bath within 24 hours of delivery and 19% reported use of herbs. Caregivers practiced adequate thermal care 87%. Cord care practices were inappropriate in 36.5%. Only 21% of the respondents reported initiation of breast feeding within 1 hour of birth, Prelacteal feeds were given by 37.6% of the care givers, water being the commonest prelacteal feed followed by cow's milk at 40.4 and 18.4% respectively. Majority of the respondents had below average knowledge about danger signs in the newborn where 63% and mean score for knowledge about danger signs was 44%. Caretaker's age and relationship with the newborn were found to have a statistically significant associated to knowledge of danger signs in the newborn baby. There are variable incorrect practices in the essential new born care and low knowledge and awareness of danger signs among caregivers of newborn babies. There is high health center deliveries and antenatal care attendance among the respondents could be used as an opportunity to increase caregiver awareness about the inappropriate practices in essential newborn care and the danger signs in a newborn.
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Affiliation(s)
- Dorah Nampijja
- Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Stella Kyoyagala
- Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | | | | | | | - Lydia Kyasimire
- Mbarara University of Science and Technology, Mbarara, Uganda
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Tugume P, Mustafa AS, Walusansa A, Ojelel S, Nyachwo EB, Muhumuza E, Nampeera M, Kabbale F, Ssenku JE. Unravelling taboos and cultural beliefs associated with hidden hunger among pregnant and breast-feeding women in Buyende district Eastern Uganda. J Ethnobiol Ethnomed 2024; 20:46. [PMID: 38693532 PMCID: PMC11064283 DOI: 10.1186/s13002-024-00682-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/29/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Food taboos and cultural beliefs among pregnant and breast-feeding women influence their food consumption patterns and hence the health of women and unborn children. Cognizant of their neglect in programs aimed to ameliorate hidden hunger among pregnant and breast-feeding women in Buyende and other resource-poor communities in sub-Saharan Africa, we opted for a study to unravel them to inform program design. METHODS We documented food taboos and beliefs amongst pregnant and breast-feeding women from six sub-counties of Buyende district in Eastern Uganda. A mixed-methods approach was used, which was comprised of questionnaire interviews with 462 women, eight focus group discussions with 6-10 participants in each and a total of 15 key informant interviews. RESULTS The present study revealed that 129 (27.9%) of the respondents practice food taboos and adhere to cultural beliefs related to their dietary habits during pregnancy and breast-feeding that are fuelling the prevalence of hidden hunger. The most tabooed foods during pregnancy were sugarcane (17.8%), fishes which included lung fish, catfish and the Lake Victoria sardine (Rastrineobola argentea) (15.2%), oranges (6.6%), pineapples (5.9%), eggs (3.3%), chicken (3.3%) and cassava, mangoes and Cleome gynandra (each at 3%). Most foods were avoided for reasons associated with pregnancy and labour complications and undesirable effects on the baby. Most women learnt of the taboos and beliefs from the elders, their own mother, grandparents or mother-in-law, but there was also knowledge transmission in social groups within the community. CONCLUSIONS The taboos and cultural beliefs in the study area render pregnant and breast-feeding women prone to micronutrient deficiency since they are denied consumption of a diversity of nutritious foods. There is a need to educate such women about consumption of nutrient-rich foods like fish, eggs, fruits and vegetables in order to improve their health, that of the unborn and children being breast fed. Additionally, culturally appropriate nutrition education may be a good strategy to eliminate inappropriate food taboos and beliefs with negative impact on the health of pregnant and breast-feeding women.
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Affiliation(s)
- Patience Tugume
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Abubakar Sadik Mustafa
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Abdul Walusansa
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
- Department of Medical Microbiology, Habib Medical School, Faculty of Health Sciences, Islamic University in Uganda, P. O. Box 7689, Kampala, Uganda
| | - Samuel Ojelel
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Evelyne B Nyachwo
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Emmanuel Muhumuza
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Maria Nampeera
- Department of Health Nutrition, Buyende District Local Government, P. O. Box 87, Kamuli, Uganda
| | - Fredrick Kabbale
- Directorate of Research and Quality Assurance, Busoga University, P. O. Box 154, Iganga, Uganda
- Department of Production, Buyende District Local Government, P. O. Box 87, Kamuli, Uganda
| | - Jamilu E Ssenku
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda.
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Nabunya P, Migadde H, Namuwonge F, Mugisha J, Kirabo W, Ssentumbwe V, Claire N, Raymond A, Bahar OS, Mwebembezi A, McKay MM, Ssewamala FM. Feasibility and Acceptability of Group-Based Stigma Reduction Interventions for Adolescents Living with HIV and Their Caregivers: The Suubi4Stigma Randomized Clinical Trial (2020-2022). AIDS Behav 2024; 28:1630-1641. [PMID: 38308772 PMCID: PMC11070307 DOI: 10.1007/s10461-024-04284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Abstract
This study examined the feasibility and acceptability of two group-based interventions: group-cognitive behavioral therapy (G-CBT) and a family-strengthening intervention delivered via multiple family group (MFG-FS), to address HIV stigma among adolescents living with HIV (ALHIV) and their caregivers. A total of 147 adolescent -caregiver dyads from 9 health clinics situated within 7 political districts in Uganda were screened for eligibility. Of these, 89 dyads met the inclusion criteria and provided consent to participate in the study. Participants were randomized, at the clinic level, to one of three study conditions: Usual care, G-CBT or MFG-FS. The interventions were delivered over a 3-month period. While both adolescents and their caregivers attended the MFG-FS sessions, G-CBT sessions were only attended by adolescents. Data were collected at baseline, 3 and 6-months post intervention initiation. The retention rate was 94% over the study period. Across groups, intervention session attendance ranged between 85 and 92%, for all sessions. Fidelity of the intervention was between 85 and 100%, and both children and caregivers rated highly their satisfaction with the intervention sessions. ALHIV in Uganda, and most of sub-Saharan Africa, are still underrepresented in stigma reduction interventions. The Suubi4Stigma study was feasible and acceptable to adolescents and their caregivers -supporting testing the efficacy of the interventions in a larger trial.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA.
| | - Herbert Migadde
- International Center for Child Health and Development (ICHAD) Field Office, Masaka, Uganda
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
| | - James Mugisha
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Winnie Kirabo
- International Center for Child Health and Development (ICHAD) Field Office, Masaka, Uganda
| | - Vicent Ssentumbwe
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
| | - Najjuuko Claire
- Division of Computational & Data Sciences, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, USA
| | - Atwebembere Raymond
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
| | | | - Mary M McKay
- Office of the Vice Provost, Washington University in St. Louis, St. Louis, USA
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Brown School Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO, 63130, USA
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Tozan Y, Kiyingi J, Kim S, Nabayinda J, Namuwonge F, Nsubuga E, Nakabuye F, Sensoy OB, Nabunya P, Mayo-Wilson LJ, McKay MM, Witte SS, Ssewamala FM. Costing of a Combination Intervention (Kyaterekera) Addressing Sexual Risk-Taking Behaviors among Vulnerable Women in Southern Uganda. Am J Trop Med Hyg 2024; 110:1046-1056. [PMID: 38579695 PMCID: PMC11066365 DOI: 10.4269/ajtmh.23-0485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/25/2024] [Indexed: 04/07/2024] Open
Abstract
In Uganda, women engaged in sex work (WESW) are a marginalized population at the intersection of multiple vulnerabilities. The Kyaterekera intervention is targeted at WESW in Rakai and the greater Masaka regions in Uganda and combines a traditional HIV risk-reduction approach with a savings-led economic empowerment intervention and financial literacy training. We estimated the economic costs of the Kyaterekera intervention from a program provider perspective using a prospective activity-based micro-costing method. All program activities and resource uses were measured and valued across the control arm receiving a traditional HIV risk-reduction intervention and the treatment arm receiving a matched individual development savings account and financial literacy training on top of HIV risk reduction. The total per-participant cost by arm was adjusted for inflation and discounted at an annual rate of 3% and presented in 2019 US dollars. The total per-participant costs of the control and intervention arms were estimated at $323 and $1,435, respectively, using the per-protocol sample. When calculated based on the intent-to-treat sample, the per-participant costs were reduced to $183 and $588, respectively. The key cost drivers were the capital invested in individual development accounts and personnel and transportation costs for program operations, linked to WESW's higher mobility and the dispersed pattern of hot spot locations. The findings provide evidence of the economic costs of implementing a targeted intervention for this marginalized population in resource-constrained settings and shed light on the scale of potential investment needed to better achieve the health equity goal of HIV prevention strategies.
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Affiliation(s)
- Yesim Tozan
- School of Global Public Health, New York University, New York, New York
| | - Joshua Kiyingi
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Sooyoung Kim
- School of Global Public Health, New York University, New York, New York
| | | | - Flavia Namuwonge
- International Center for Child Health and Development, Masaka, Uganda
| | - Edward Nsubuga
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Fatuma Nakabuye
- International Center for Child Health and Development, Masaka, Uganda
| | - Ozge Bahar Sensoy
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Larissa Jennings Mayo-Wilson
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mary M. McKay
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Susan S. Witte
- Columbia University School of Social Work, New York, New York
| | - Fred M. Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, Missouri
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Mujugira A, Karungi B, Mugisha J, Nakyanzi A, Nampewo O, Naddunga F, Kamusiime B, Nsubuga R, Nyanzi KR, Muwonge TR, Wyatt MA, Ware NC, Gandhi M, Haberer JE. Urine tenofovir testing for real-time PrEP adherence feedback: a qualitative study involving transgender women in Uganda. J Int AIDS Soc 2024; 27:e26255. [PMID: 38695107 PMCID: PMC11063774 DOI: 10.1002/jia2.26255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/15/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION Adherence counselling with point-of-care (POC) drug-level feedback using a novel tenofovir assay may support pre-exposure prophylaxis (PrEP) adherence; however, perceptions of urine testing and its impact on adherence are not well studied. We qualitatively examined how POC tenofovir testing was experienced by transgender women (TGW) in Uganda. METHODS Within a cluster randomized trial of peer-delivered HIV self-testing, self-sampling for sexually transmitted infections and PrEP among HIV-negative TGW showing overall low PrEP prevention-effective adherence (NCT04328025), we conducted a nested qualitative sub-study of the urine POC assay among a random sample of 30 TGW (August 2021-February 2022). TGW interviews explored: (1) experiences with POC urine tenofovir testing and (2) perceptions of PrEP adherence counselling with drug-level feedback. We used an inductive content analytic approach for analysis. RESULTS Median age was 21 years (interquartile range 20-24), and 70% engaged in sex work. Four content categories describe how TGW experienced POC urine tenofovir testing: (1) Urine tenofovir testing was initially met with scepticism: Testing urine to detect PrEP initially induced anxiety, with some perceptions of being intrusive and unwarranted. With counselling, however, participants found POC testing acceptable and beneficial. (2) Alignment of urine test results and adherence behaviours: Drug-level feedback aligned with what TGW knew about their adherence. Concurrence between pill taking and tenofovir detection in urine reinforced confidence in test accuracy. (3) Interpretation of urine tenofovir results: TGW familiar with the interpretation of oral-fluid HIV self-tests knew that two lines on the test device signified positivity (presence of HIV). However, two lines on the urine test strip indicated a positive result for non-adherence (absence of tenofovir), causing confusion. Research nurses explained the difference in test interpretation to participants' satisfaction. (4) White coat dosing: Some TGW deliberately chose not to attend scheduled clinic appointments to avoid detecting their PrEP non-adherence during urine testing. They restarted PrEP before returning to clinic, a behaviour called "white coat dosing." CONCLUSIONS Incorporating POC urine testing into routine PrEP adherence counselling was acceptable and potentially beneficial for TGW but required attention to context. Additional research is needed to identify effective strategies for optimizing adherence monitoring and counselling for this population.
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Affiliation(s)
- Andrew Mujugira
- The Infectious Diseases Institute LimitedMakerere UniversityKampalaUganda
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | | | - Jackson Mugisha
- The Infectious Diseases Institute LimitedMakerere UniversityKampalaUganda
| | - Agnes Nakyanzi
- The Infectious Diseases Institute LimitedMakerere UniversityKampalaUganda
| | - Olivia Nampewo
- The Infectious Diseases Institute LimitedMakerere UniversityKampalaUganda
| | - Faith Naddunga
- The Infectious Diseases Institute LimitedMakerere UniversityKampalaUganda
| | - Brenda Kamusiime
- The Infectious Diseases Institute LimitedMakerere UniversityKampalaUganda
| | - Rogers Nsubuga
- The Infectious Diseases Institute LimitedMakerere UniversityKampalaUganda
| | - Kikulwe R. Nyanzi
- The Infectious Diseases Institute LimitedMakerere UniversityKampalaUganda
| | - Timothy R. Muwonge
- The Infectious Diseases Institute LimitedMakerere UniversityKampalaUganda
| | - Monique A. Wyatt
- Department of Global Health and Social MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Harvard GlobalCambridgeMassachusettsUSA
| | - Norma C. Ware
- Department of Global Health and Social MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Department of MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Monica Gandhi
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Jessica E. Haberer
- Harvard Medical SchoolBostonMassachusettsUSA
- Centre for Global HealthMassachusetts General HospitalBostonMassachusettsUSA
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Pezaro DS, Zarbiv G, Jones J, Feika ML, Fitzgerald L, Lukhele S, Mcmillan-Bohler J, Baloyi OB, Maravic da Silva K, Grant C, Bayliss-Pratt L, Hardtman P. Characteristics of strong midwifery leaders and enablers of strong midwifery leadership: An international appreciative inquiry. Midwifery 2024; 132:103982. [PMID: 38579551 DOI: 10.1016/j.midw.2024.103982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 02/22/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES This research aimed to identify the characteristics of strong midwifery leaders and explore how strong midwifery leadership may be enabled from the perspective of midwives and nurse-midwives globally. DESIGN In this appreciative inquiry, we collected qualitative and demographic data using a cross-sectional online survey between February and July 2022. SETTING Responses were received from many countries (n = 76), predominantly the United Kingdom (UK), Australia, the United States of America (USA), Canada, Uganda, Saudi Arabia, Tanzania, Rwanda, India, and Kenya. PARTICIPANTS An international population (n = 429) of English-speaking, and ethnically diverse midwives (n = 211) and nurse-midwives (n = 218). MEASUREMENTS Reflexive thematic analysis was used to make sense of the qualitative data collected. Identified characteristics of strong midwifery leadership were subsequently deductively mapped to established leadership styles and leadership theories. Demographic data were analysed using descriptive statistics. FINDINGS Participants identified strong midwifery leaders as being mediators, dedicated to the profession, evidence-based practitioners, effective decision makers, role models, advocates, visionaries, resilient, empathetic, and compassionate. These characteristics mapped to compassionate, transformational, servant, authentic, and situational leadership styles. To enable strong midwifery leadership, participants identified a need for investment in midwives' clear professional identity, increased societal value placed upon the midwifery profession, ongoing research, professional development in leadership, interprofessional collaborations, succession planning and increased self-efficacy. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE This study contributes to understandings of trait, behavioural, situational, transformational and servant leadership theory in the context of midwifery. Investing in the development of strong midwifery leadership is essential as it has the potential to elevate the profession and improve perinatal outcomes worldwide. Findings may inform the development of both existing and new leadership models, frameworks, and validated measurement tools.
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Affiliation(s)
- Dr Sally Pezaro
- Research Centre for Healthcare and Communities, Coventry University, UK; Adjunct Associate Professor, University of Notre Dame, Australia.
| | - Gila Zarbiv
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jude Jones
- TALENT Groups Project Manager, University of Salford, Salford, United Kingdom
| | | | - Laura Fitzgerald
- Jhpiego, an affiliate of Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Jacquelyn Mcmillan-Bohler
- Duke University, School of Nursing, 307 Trent Drive, Durham, NC 27710, 2043 Pearson Hall, North Carolina, United States of America
| | - Olivia B Baloyi
- University of KwaZulu-Natal, School of Nursing and Public Health, Durban, South Africa
| | | | - Christine Grant
- The Centre for Healthcare Research, Coventry University, United Kingdom
| | - Lisa Bayliss-Pratt
- Director - Chief Academic Officer Fatima College of Health Sciences. United Arab Emirates
| | - Pandora Hardtman
- Chief Nursing and Midwifery Officer, Jhpiego, United States of America
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Palmer J, Sokiri S, Char JNB, Vivian A, Ferris D, Venner G, Dak JJ. From humanitarian crisis to employment crisis: The lives and livelihoods of South Sudanese refugee health workers in Uganda. Int J Health Plann Manage 2024; 39:671-688. [PMID: 38326292 DOI: 10.1002/hpm.3777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/09/2024] Open
Abstract
Despite the many benefits of refugee health workers for health systems, they commonly face challenges integrating into host country workforces. The Global Code of Practice on International Recruitment of Health Personnel, which should monitor and protect migrant health workers, offers little guidance for refugees and research is needed to inform strategy. Based on interviews with 34 refugee health workers and 10 leaders across two settlements supporting populations fleeing the humanitarian crisis in South Sudan since 2013, we describe the governance and social dynamics affecting South Sudanese refugee health worker employment in Uganda. Refugees in Uganda legally have the right to work but face an employment crisis. Refugee health workers report that systemic discrimination, competition from underemployed domestic workers, unclear work permit rules and expensive credentialling processes exclude them from meaningful work in public health facilities and good jobs in the humanitarian response. This pushes them into unchallenging roles in private clinics, poorly remunerated positions on village health teams or out of the health sector altogether. Health system strengthening initiatives in Uganda to integrate humanitarian and government services and to deter the domestic workforce from emigration have overlooked the potential contributions of refugee health workers and the employment crisis they face. More effort is needed to increase fairness in public sector recruitment practices for refugee health workers, support credentialling, training opportunities for professional and non-professional cadres, job placements, and to draw attention to the public benefits of refugee health worker employment alongside higher spending on human resources for health.
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Affiliation(s)
- Jennifer Palmer
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen Sokiri
- South Sudanese Women Building Association, Kampala, Uganda
| | | | | | | | - Georgia Venner
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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31
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Vasireddy V, Brown NE, Shah N, Crowell TA. Sustaining HIV service delivery to key population clients using client-centered models during the debate and enactment of the Anti-Homosexuality Act in Uganda. J Int AIDS Soc 2024; 27:e26253. [PMID: 38712676 DOI: 10.1002/jia2.26253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024] Open
Affiliation(s)
- Vamsi Vasireddy
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- U.S. Mission to Uganda, Kampala, Uganda
| | - Natalie E Brown
- U.S. Mission to Uganda, Kampala, Uganda
- U.S. Department of State and Smithsonian Institution, Washington, DC, USA
| | - Neha Shah
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
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Mujugira A, Muwonge T, Aliganyira B, Okoboi S. Uganda's Anti-Homosexuality Act undermines public health. J Int AIDS Soc 2024; 27:e26259. [PMID: 38712671 DOI: 10.1002/jia2.26259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/18/2024] [Indexed: 05/08/2024] Open
Affiliation(s)
- Andrew Mujugira
- The Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Timothy Muwonge
- The Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Stephen Okoboi
- The Infectious Diseases Institute, Makerere University, Kampala, Uganda
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Wang L, Muwonge TR, Simoni JM, Nambi F, Nakabugo L, Kibuuka J, Thomas D, Katz IT, Feutz E, Thomas KK, Ware NC, Wyatt MA, Kadama H, Mujugira A, Heffron R. Behavioral Modeling and its Association with PrEP and ART Use in Ugandan HIV-Serodifferent Couples. AIDS Behav 2024; 28:1719-1730. [PMID: 38361169 PMCID: PMC11069469 DOI: 10.1007/s10461-024-04286-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
Integrating Pre-Exposure Prophylaxis (PrEP) delivery into Antiretroviral Therapy (ART) programs bridges the Human Immunodeficiency Virus (HIV) prevention gap for HIV-serodifferent couples prior to the partner living with HIV achieving viral suppression. Behavioral modeling is one mechanism that could explain health-related behavior among couples, including those using antiretroviral medications, but few tools exist to measure the extent to which behavior is modeled. Using a longitudinal observational design nested within a cluster randomized trial, this study examined the factor structure and assessed the internal consistency of a novel 24-item, four-point Likert-type scale to measure behavioral modeling and the association of behavioral modeling with medication-taking behaviors among heterosexual, cis-gender HIV-serodifferent couples. In 149 couples enrolled for research, a five-factor model provided the best statistical and conceptual fit, including attention to partner behavior, collective action, role modeling, motivation, and relationship quality. Behavioral modeling was associated with medication-taking behaviors among members of serodifferent couples. Partner modeling of ART/PrEP taking could be an important target for assessment and intervention in HIV prevention programs for HIV serodifferent couples.
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Affiliation(s)
- Liying Wang
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Behavioral and Social Sciences Research, NIH, Bethesda, Maryland, USA
- Office of Behavioral and Social Sciences Research (OBSSR), NIH, Bethesda, Maryland, USA
- Division of Program Coordination, Planning and Strategic Initiatives (DPCPSI), NIH, Bethesda, Maryland, USA
- National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Florence Nambi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Joseph Kibuuka
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Dorothy Thomas
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Ingrid T Katz
- Department of Global Health and Social Medicine, Harvard Medical School, 25 Shattuck St, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, Massachusetts, USA
| | - Erika Feutz
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Norma C Ware
- Department of Global Health and Social Medicine, Harvard Medical School, 25 Shattuck St, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, Massachusetts, USA
| | - Monique A Wyatt
- Department of Global Health and Social Medicine, Harvard Medical School, 25 Shattuck St, Boston, Massachusetts, USA
- Harvard Global, Cambridge, MA, USA
| | | | - Andrew Mujugira
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, WA, USA.
- Department of Medicine, University of Alabama at Birmingham, 845 19th Street South Bevill Biomedical Research Building, Room 256D, Birmingham, AL, 35294-2170, USA.
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Nabayinda J, Witte SS, Kizito S, Nanteza F, Nsubuga E, Sensoy Bahar O, Nabunya P, Ssewamala FM. The impact of an economic empowerment intervention on intimate partner violence among women engaged in sex work in southern Uganda: A cluster randomized control trial. Soc Sci Med 2024; 348:116846. [PMID: 38581814 DOI: 10.1016/j.socscimed.2024.116846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/20/2024] [Accepted: 03/27/2024] [Indexed: 04/08/2024]
Abstract
Women engaged in sex work (WESW) are at heightened risk of experiencing intimate partner violence (IPV) compared to women in the general population. This study examines the impact of an economic empowerment intervention on IPV among WESW in Southern Uganda. We used data from 542 WESW in Southern Uganda recruited from 19 HIV hotspots between June 2019 and March 2020. Eligible participants were 18+ years old, engaged in sex work-defined as vaginal or anal sexual intercourse in exchange for money, alcohol, or other goods, reported at least one episode of unprotected sexual intercourse in the past 30 days with a paying, casual, or regular sexual partner (spouse, main partner). We analyzed data collected at baseline, 6, and 12months of follow up. To examine the impact of the intervention on IPV, separate mixed-effects logistic regression models were run for each type of IPV (physical, emotional, and sexual) as experienced by participants in the last 90 days. Results show that the intervention was efficacious in reducing emotional and physical IPV as evidenced by a statistically significant intervention main effect for emotional IPV, χ2(1) = 5.96, p = 0.015, and a significant intervention-by-time interaction effect for physical IPV, χ2(2) = 13.19, p < 0.001. To qualify the intervention impact on physical IPV, pairwise comparisons showed that participants who received the intervention had significantly lower levels of physical IPV compared to those in the control group at six months (contrasts = -0.12 (95% CI: -0.22, -0.02), p = 0.011). The intervention, time, and intervention-by-time main effects for sexual IPV were not statistically significant. Our findings suggest economic empowerment interventions as viable strategies for reducing emotional IPV among WESW. However, it is also essential to understand the role of interventions in addressing other forms of IPV especially for key populations at high risk of violence, HIV, and STI. The study was registered at ClinicalTrials.gov, ID: NCT03583541.
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Affiliation(s)
- Josephine Nabayinda
- Washington University in St. Louis Brown School, International Center for Child Health, and Development (ICHAD), 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Susan S Witte
- Columbia University, School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Samuel Kizito
- Washington University in St. Louis Brown School, International Center for Child Health, and Development (ICHAD), 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Flavia Nanteza
- International Center for Child Health and Development (ICHAD), Masaka Office, Uganda
| | - Edward Nsubuga
- Washington University in St. Louis Brown School, International Center for Child Health, and Development (ICHAD), 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Ozge Sensoy Bahar
- Washington University in St. Louis Brown School, International Center for Child Health, and Development (ICHAD), 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Proscovia Nabunya
- Washington University in St. Louis Brown School, International Center for Child Health, and Development (ICHAD), 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Fred M Ssewamala
- Washington University in St. Louis Brown School, International Center for Child Health, and Development (ICHAD), 1 Brookings Drive, St. Louis, MO, 63130, USA.
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Freymann E, d'Oliveira Coelho J, Hobaiter C, Huffman MA, Muhumuza G, Zuberbühler K, Carvalho S. Applying collocation and APRIORI analyses to chimpanzee diets: Methods for investigating nonrandom food combinations in primate self-medication. Am J Primatol 2024; 86:e23603. [PMID: 38293796 DOI: 10.1002/ajp.23603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 12/12/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024]
Abstract
Identifying novel medicinal resources in chimpanzee diets has historically presented challenges, requiring extensive behavioral data collection and health monitoring, accompanied by expensive pharmacological analyses. When putative therapeutic self-medicative behaviors are observed, these events are often considered isolated occurrences, with little attention paid to other resources ingested in combination. For chimpanzees, medicinal resource combinations could play an important role in maintaining well-being by tackling different symptoms of an illness, chemically strengthening efficacy of a treatment, or providing prophylactic compounds that prevent future ailments. We call this concept the self-medicative resource combination hypothesis. However, a dearth of methodological approaches for holistically investigating primate feeding ecology has limited our ability to identify nonrandom resource combinations and explore potential synergistic relationships between medicinal resource candidates. Here we present two analytical tools that test such a hypothesis and demonstrate these approaches on feeding data from the Sonso chimpanzee community in Budongo Forest, Uganda. Using 4 months of data, we establish that both collocation and APRIORI analyses are effective exploratory tools for identifying binary combinations, and that APRIORI is effective for multi-item rule associations. We then compare outputs from both methods, finding up to 60% agreement, and propose APRIORI as more effective for studies requiring control over confidence intervals and those investigating nonrandom associations between more than two resources. These analytical tools, which can be extrapolated across the animal kingdom, can provide a cost-effective and efficient method for targeting resources for further pharmacological investigation, potentially aiding in the discovery of novel medicines.
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Affiliation(s)
- Elodie Freymann
- Primate Models for Behavioural Evolution Lab, Department of Anthropology and Museum Ethnography, Institute of Human Sciences, University of Oxford, Oxford, UK
| | - João d'Oliveira Coelho
- Primate Models for Behavioural Evolution Lab, Department of Anthropology and Museum Ethnography, Institute of Human Sciences, University of Oxford, Oxford, UK
| | - Catherine Hobaiter
- Budongo Conservation Field Station, Masindi, Uganda
- Wild Minds Lab, School of Psychology and Neuroscience, University of St Andrews, St Andrews, UK
| | - Michael A Huffman
- Wildlife Research Center, Inuyama Campus, Kyoto University, Inuyama, Japan
| | | | - Klaus Zuberbühler
- Budongo Conservation Field Station, Masindi, Uganda
- Department of Comparative Cognition, Institute of Biology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Susana Carvalho
- Primate Models for Behavioural Evolution Lab, Department of Anthropology and Museum Ethnography, Institute of Human Sciences, University of Oxford, Oxford, UK
- Interdisciplinary Centre for Archaeology and the Evolution of Human Behaviour, University of Algarve, Faro, Portugal Gorongosa National Park, Sofala, Mozambique
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Rodriguez CA, Natukunda E, Strehlau R, Venter EL, Rungmaitree S, Cunningham CK, Lalloo U, Kosalaraksa P, HellstrÖm E, Liberty A, McGrath EJ, Kaur M, Leisegang R, Hindman JT, Vieira VA, Kersey K, Cotton MF, Rakhmanina N, Gaur AH. Pharmacokinetics and safety of coformulated bictegravir, emtricitabine, and tenofovir alafenamide in children aged 2 years and older with virologically suppressed HIV: a phase 2/3, open-label, single-arm study. Lancet HIV 2024; 11:e300-e308. [PMID: 38621393 DOI: 10.1016/s2352-3018(23)00327-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/03/2023] [Accepted: 11/28/2023] [Indexed: 04/17/2024]
Abstract
BACKGROUND Coformulated bictegravir, emtricitabine, and tenofovir alafenamide is a single-tablet regimen and was efficacious and well tolerated in children and adolescents with HIV (aged 6 years to <18 years) in a 48-week phase 2/3 trial. In this study, we report data from children aged at least 2 years and weighing 14 kg to less than 25 kg. METHODS We conducted this open-label, multicentre, multicohort, single-arm study in South Africa, Thailand, Uganda, and the USA. Participants were virologically suppressed children with HIV, aged at least 2 years, weighing 14 kg to less than 25 kg. Participants received bictegravir (30 mg), emtricitabine (120 mg), and tenofovir alafenamide (15 mg) once daily, switching to bictegravir (50 mg), emtricitabine (200 mg), and tenofovir alafenamide (25 mg) upon attaining a bodyweight of at least 25 kg. The study included pharmacokinetic evaluation at week 2 to confirm the dose of coformulated bictegravir, emtricitabine, and tenofovir alafenamide for this weight band by comparing with previous adult data. Primary outcomes were bictegravir area under the curve over the dosing interval (AUCtau) and concentration at the end of the dosing interval (Ctau) at week 2, and incidence of treatment-emergent adverse events and laboratory abnormalities until the end of week 24 in all participants who received at least one dose of bictegravir, emtricitabine, and tenofovir alafenamide. This study is registered with ClinicalTrials.gov, NCT02881320. FINDINGS Overall, 22 participants were screened (from Nov 14, 2018, to Jan 11, 2020), completed treatment with bictegravir, emtricitabine, and tenofovir alafenamide (until week 48), and entered an extension phase. The geometric least squares mean (GLSM) ratio for AUCtau for bictegravir was 7·6% higher than adults (GLSM ratio 107·6%, 90% CI 96·7-119·7); Ctau was 34·6% lower than adults (65·4%, 49·1-87·2). Both parameters were within the target exposure range previously found in adults, children, or both". Grade 3-4 laboratory abnormalities occurred in four (18%) participants by the end week 24 and six (27%) by the end of week 48. Drug-related adverse events occurred in three participants (14%) by the end of week 24 and week 48; none were severe. No Grade 3-4 adverse events, serious adverse events, or adverse events leading to discontinuation occurred by the end of week 24 and week 48. INTERPRETATION Data support the use of single-tablet coformulated bictegravir (30 mg), emtricitabine (120 mg), and tenofovir alafenamide (15 mg) for treatment of HIV in children aged at least 2 years and weighing 14 kg to less than 25 kg. FUNDING Gilead Sciences.
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Affiliation(s)
- Carina A Rodriguez
- Department of Pediatrics, Division of Infectious Diseases, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | - Renate Strehlau
- VIDA-Nkanyezi Research Unit, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Supattra Rungmaitree
- Department of Paediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Coleen K Cunningham
- School of Medicine, University of California Irvine (UCI), Irvine, CA, USA; Children's Hospital of Orange County, Orange, CA, USA
| | - Umesh Lalloo
- Durban International Clinical Research Site, Durban University of Technology, Durban, South Africa
| | - Pope Kosalaraksa
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Afaaf Liberty
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Eric J McGrath
- Division of Infectious Diseases & Prevention, Wayne State University School of Medicine, Detroit, MI, USA
| | | | | | | | | | | | - Mark F Cotton
- Department of Paediatrics and Child Health, Family Centre for Research with Ubuntu (FAMCRU), Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Natella Rakhmanina
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA; School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA; Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
| | - Aditya H Gaur
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USA.
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Rutakumwa R, Knizek BL, Tusiime C, Mpango RS, Birungi C, Kinyanda E. Victimisation in the life of persons with severe mental illness in Uganda: a pluralistic qualitative study. BMC Psychiatry 2024; 24:329. [PMID: 38689240 PMCID: PMC11061965 DOI: 10.1186/s12888-024-05720-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/26/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Victimisation of persons with severe mental illness is recognised as an urgent global concern, with literature pointing to higher rates of violent victimisation of persons with severe mental illness than those of the general population. Yet, for low income countries, there is a huge gap in the literature on the risk, character and victims' in-depth experiences of victimisation of persons with severe mental illness. We explore the lived experiences and meanings of victimisation of persons with severe mental illness in Uganda, and discuss their implications for care of the mentally ill. METHODS A pluralistic qualitative study was undertaken to explore victimisation among patients with severe mental illness. Patients who had suffered victimisation were purposively sampled from Butabika National Referral Mental Clinic and Masaka Regional Referral Hospital, following confirmation of symptom remission. In-depth interviews were held with 18 participants, comprising 13 females and 5 males from low to moderate socioeconomic status. Interpretative phenomenological analysis and thematic content analysis were conducted. RESULTS Victimisation was exhibited in three main forms: (a) psychological, expressed in attitudes towards mentally ill family members as valueless and dispensable, and stigmatisation, (b) physical, as manifested in beatings, indoor confinement and tethering mostly by family members and (c) sexual victimisation, particularly rape. Also observed were victim's various responses that pointed to the negative impact of victimisation, including a heightened risk of suicide, social withdrawal, a sense of hatefulness and a predisposition to more victimisation. CONCLUSION The family environment plays a predominant role in perpetrating victimisation of the mentally ill in some sub-Saharan African contexts such as Uganda. We propose a holistic framework for mental health interventions, incorporating biomedical but notably also social determinants of mental health, and targeted at improving familial relationships, social support and a sense of belongingness both within the family and the broader community.
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Affiliation(s)
- Rwamahe Rutakumwa
- Medical Research Council, Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Plot 50-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda.
| | - Birthe Loa Knizek
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Trøndelag, Norway
| | - Christine Tusiime
- Medical Research Council, Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Plot 50-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
- Butabika National Referral Mental Hospital, Old Port Bell Road, P. O. Box 7017, Kampala, Uganda
| | - Richard Stephen Mpango
- Medical Research Council, Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Plot 50-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Carol Birungi
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Eugene Kinyanda
- Medical Research Council, Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Plot 50-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
- Department of Psychiatry, Makerere University, P. O. Box 7072, Kampala, Uganda
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Kimbugwe G, Vatrinet R, Mwanga JA, Kakuru R, Mpeirwe D, Logoose S, Opio K, Kambale M, Seeley J, Grais RF, Marquer C, Kaleebu P, Ssali A. Perceptions, attitudes, and willingness of healthcare and frontline workers to participate in an Ebola vaccine trial in Uganda. Vaccine 2024; 42:3002-3008. [PMID: 38565464 DOI: 10.1016/j.vaccine.2024.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/16/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Understanding the knowledge, perception and attitudes towards Ebola vaccines is an important factor in ensuring future use of these vaccines. A qualitative methods study embedded in an Ebola vaccine immunogenicity and safety trial (NCT04028349) was conducted to explore the knowledge and perceptions of healthcare (HCWs) and frontline workers (FLWs), about Ebola vaccines and their willingness to participate or recommend participation in Uganda. METHOD We carried out focus group discussions and semi-structured interviews before and after vaccination, with 70 HCWs and FLWs who consented to participate in the trial, and in the qualitative component, from August to September 2019. Data were analysed using thematic content analysis. RESULTS Respondents showed good knowledge about Ebola and the vaccines in general, and had wide access to information through several channels, including the study team. On prevention, particular attention was given to effective communication within health facilities. Misconceptions were mainly around route of transmission, animal origin and types of vaccines. Previous fears were based on rumours circulating in the community, mainly about the presence of the virus in the vaccine, side effects and intention to harm (e.g. by "the whites"), ultimately insisting on transparency, trust and involvement of local leaders. Acceptability of participation was motivated by the need to protect self and others, and the willingness to advance research. Majority were willing to recommend participation to their community. CONCLUSIONS Overall, information sharing leads to a better understanding and acceptance of vaccine trials and a positive vaccination experience can be a deciding factor in the acceptance of others. Particular attention should be paid to involving the community in addressing misconceptions and fears, while ensuring that participants have access to vaccination sites in terms of transport, and that they are properly accommodated at the study site including staying for a reasonable period of time.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Janet Seeley
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Pontiano Kaleebu
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda; Uganda Virus Research Institute, Entebbe, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Agnes Ssali
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom
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Ocan M, Nakalembe L, Otike C, Mordecai T, Birungi J, Nsobya S. Access to quality-assured artemisinin-based combination therapy and associated factors among clients of selected private drug outlets in Uganda. Malar J 2024; 23:128. [PMID: 38689257 PMCID: PMC11059854 DOI: 10.1186/s12936-024-04956-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Malaria treatment in sub-Saharan Africa is faced with challenges including unreliable supply of efficacious agents, substandard medicines coupled with high price of artemisinin-based combinations. This affects access to effective treatment increasing risk of malaria parasite resistance development and adverse drug events. This study investigated access to quality-assured artemisinin-based combination therapy (QAACT) medicines among clients of selected private drug-outlets in Uganda. METHODS This was a cross sectional study where exit interviews were conducted among clients of private drug outlets in low and high malaria transmission settings in Uganda. This study adapted the World Health Organization/Health Action International (WHO/HAI) standardized criteria. Data was collected using a validated questionnaire. Data entry screen with checks was created in Epi-data ver 4.2 software and data entered in duplicate. Data was transferred to STATA ver 14.0 and cleaned prior to analysis. The analysis was done at 95% level of significance. RESULTS A total of 1114 exit interviews were conducted among systematically sampled drug outlet clients. Over half, 54.9% (611/1114) of the participants were males. Majority, 97.2% (1083/1114) purchased an artemisinin-based combination anti-malarial. Most, 55.5% (618/1114) of the participants had a laboratory diagnosis of malaria. Majority, 77.9% (868/1114) of the participants obtained anti-malarial agents without a prescription. Less than a third, 27.7% (309/1114) of the participants obtained a QAACT. Of the participants who obtained QAACT, more than half 56.9% (173/309) reported finding the medicine expensive. The predictors of accessing a QAACT anti-malarial among drug outlet clients include type of drug outlet visited (aPR = 0.74; 95%CI 0.6, 0.91), not obtaining full dose (3-day treatment) of ACT (aPR = 0.49; 95%CI 0.33, 0.73), not finding the ACT expensive (aPR = 1.24; 95%CI 1.03, 1.49), post-primary education (aPR = 1.29; 95%CI 1.07,1.56), business occupation (aPR = 1.24; 95%CI 1.02,1.50) and not having a prescription (aPR = 0.76; 95%CI 0.63, 0.92). CONCLUSION Less than a third of the private drug outlet clients obtained a QAACT for management of malaria symptoms. Individuals who did not find artemisinin-based combinations to be expensive were more likely to obtain a QAACT anti-malarial. The Ministry of Health needs to conduct regular surveillance to monitor accessibility of QAACT anti-malarial agents under the current private sector copayment mechanism.
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Affiliation(s)
- Moses Ocan
- Department of Pharmacology & Therapeutics, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda.
| | - Loyce Nakalembe
- Department of Pharmacology, Soroti University, P. O. Box 211, Soroti, Uganda
| | - Caroline Otike
- Data Department, Joint Clinical Research Centre, Lubowa, P. O Box 10005, Kampala, Uganda
| | - Tayebwa Mordecai
- Makerere University College of Health Sciences Grants Office, P. Box 7072, Kampala, Uganda
| | - Joan Birungi
- Department of Molecular Biology and Immunology, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda
| | - Sam Nsobya
- Department of Pathology, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
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Sensalire S, Nkolo A, Ssali JN, Muhire M, Muhwezi A, Kadama H. Applying a Three-Tier Approach to Address Gaps in Oral Pre-Exposure Prophylaxis Uptake and Continuity in Uganda: A Mixed Methods Approach. Glob Health Sci Pract 2024; 12:e2300229. [PMID: 38467398 PMCID: PMC11057795 DOI: 10.9745/ghsp-d-23-00229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/13/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND We describe a 3-tier approach involving a gap analysis, root cause analysis, and pre-exposure prophylaxis (PrEP) collaborative to understand the gap and identify and address the main barriers to oral PrEP uptake and continuity in Uganda. METHODS We used a mixed methods design with retrospective, cross-sectional, and prospective components. The gap analysis involved descriptive analysis of PrEP uptake and continuity. The RCA identified the main barriers to initiation and continuity on PrEP among 1,334 clients who declined to start PrEP and 1,266 who missed their appointment but were at risk. The PrEP collaborative tested changes mapped onto specific barriers to optimize the PrEP clinical service delivery. A trend analysis of routinely collected data of the PrEP cascade determined significant shifts and trends in PrEP uptake and continuity. RESULTS Only 60% of the high-risk population eligible for PrEP were enrolled, while fewer than 30% of the cumulative number of PrEP users were refilled each quarter. Uncertainty and fear of side effects, perceptions about the harmfulness of the medication, perceived inability to adhere to PrEP, and stigma were the main reasons why clients rejected PrEP. Lack of access to the facility, side effects, pill burden, stigma, perceived low-risk exposure to HIV, and preference of staying at work as opposed to picking up refills affected continuity on PrEP. The collaborative registered statistically significant shifts in PrEP enrollment from 64% to 89% and continuity from 51% to 78% between July 21 and November 22 following the collaborative intervention. CONCLUSIONS We recommend using a 3-tier approach for other similar implementation contexts to strengthen PrEP programming, given the marked statistical shift in PrEP uptake and continuity. This begins with understanding the gap and barriers to use among clients, followed by mapping interventions to specific barriers through a quality improvement collaborative.
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Affiliation(s)
- Simon Sensalire
- U.S. Agency for International Development Uganda Health Activity, Kampala, Uganda.
| | - Abel Nkolo
- University Research Co., LLC, Washington, DC, USA
| | | | - Martin Muhire
- U.S. Agency for International Development Uganda Health Activity, Kampala, Uganda
| | - Augustin Muhwezi
- U.S. Agency for International Development Uganda Health Activity, Kampala, Uganda
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Gumisirizah N, Nzabahimana J, Muwonge CM. Students' performance, attitude, and classroom observation data to assess the effect of problem-based learning approach supplemented by YouTube videos in Ugandan classroom. Sci Data 2024; 11:428. [PMID: 38664410 PMCID: PMC11045739 DOI: 10.1038/s41597-024-03206-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
In response to global demands, Uganda's Vision 2040 seeks to transform the country into a modern and prosperous nation by implementing Sustainable Development Goal (SDG) 4, focusing on equitable and quality education. The 21st-century workforce requires individuals who can effectively navigate complex workplace challenges. This dataset was gathered from Form-2 Ugandan secondary school students (aged 12 to 15) across 12 schools in the Sheema District. The dataset comprises three types of data: students' performance in a physics topic (simple machines), their attitudes toward problem-solving and critical thinking when learning physics using Problem-Based Learning (PBL) supplemented by YouTube videos, and classroom observations documented with the reformed teaching observational protocol (RTOP). The intervention of teaching using PBL was executed in 2022, collecting data from 973 lower secondary school students. The intervention involved three approaches: one group (144 students) received PBL along with YouTube videos, another group of 482 students received PBL alone, and a third group (347 students) was taught using the traditional method. This data article explains the study's data creation, collection, and analysis process. The dataset holds significance for secondary school teachers, policymakers, and researchers, offering insights into the impact of PBL with and without ICT resources on learning physics and students' attitudes toward these learner-centered approaches.
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Affiliation(s)
- Nicholus Gumisirizah
- African Center of Excellence for Innovative Teaching and Learning Mathematics and Science (ACEITLMS), University of Rwanda College of Education (URCE), Kayonza, P.O Box 55, Rwamagana, Rwanda.
| | - Joseph Nzabahimana
- African Center of Excellence for Innovative Teaching and Learning Mathematics and Science (ACEITLMS), University of Rwanda College of Education (URCE), Kayonza, P.O Box 55, Rwamagana, Rwanda
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Kigongo E, Tumwesigye R, Anyolitho MK, Musinguzi M, Kwizera G, Achan E, Nabasirye CK, Udho S, Kabunga A, Omech B. Access to family planning services and associated factors among young people in Lira city northern Uganda. BMC Public Health 2024; 24:1146. [PMID: 38658880 PMCID: PMC11044454 DOI: 10.1186/s12889-024-18605-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Access to family planning services among young people is crucial for reproductive health. This study explores the access and associated factors among young people in Lira City, Northern Uganda. METHODS AND MATERIALS A mixed-methods study was conducted in March to April 2022. Quantitative data were collected using a structured questionnaire from 553 participants aged 15-24 years. Qualitative data were obtained through in-depth interviews and focus group discussions. Data analysis included univariate, bivariate, and multivariate analyses for quantitative data, while interpretative phenomenological analysis was used for qualitative data. RESULTS Overall, 31.7% of the respondents had a good perceived access to family planning services, with 64.6% reporting perceived availability of FP methods. Challenges included lack of privacy (57.7%), fear of mistreatment (77.2%), and decision-making difficulties (66.2%). Among females, good perceived access to FP services was less likely among urban residents (AOR: 0.22, 95% CI: 0.09-0.53), Christian respondents (AOR: 0.51, 95% CI: 0.01-0.36), Muslim respondents (AOR: 0.07, 95% CI: 0.01-0.55) and respondents with poor attitude to FP services (AOR: 0.39, 95% CI: 0.24-0.64), but more likely among respondents with a sexual a partner (AOR: 4.48, 95% CI: 2.60-7.75). Among males, good perceived access to FP services was less likely among respondents living with parents (AOR: 0.19, 95% CI: 0.05-0.67) but more likely among respondents with good knowledge of FP services (AOR: 2.28, 95% CI: 1.02-5.32). Qualitative findings showed that three themes emerged; knowledge of family planning methods, beliefs about youth contraception and, friendliness of family planning services. CONCLUSION The study revealed a substantial gap in perceived access to family planning services among young people in Lira City. Barriers include privacy concerns, fear of mistreatment, and decision-making difficulties. Tailored interventions addressing urban access, religious beliefs for females, and knowledge enhancement for males are essential. Positive aspects like diverse FP methods and physical accessibility provide a foundation for targeted interventions. Youth-friendly services, comprehensive sexual education, and further research are emphasized for a nuanced understanding and effective interventions in Northern Uganda.
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Affiliation(s)
- Eustes Kigongo
- Faculty of Public Health, Lira University, Lira City, Northern, P. O Box 1035, Uganda.
| | - Raymond Tumwesigye
- Faculty of Public Health, Lira University, Lira City, Northern, P. O Box 1035, Uganda
| | | | - Marvin Musinguzi
- Faculty of Public Health, Lira University, Lira City, Northern, P. O Box 1035, Uganda
| | - Gad Kwizera
- Faculty of Education, Lira University, Lira, Uganda
| | - Everlyne Achan
- Faculty of Public Health, Lira University, Lira City, Northern, P. O Box 1035, Uganda
| | | | - Samson Udho
- Faculty of Nursing , Mbarara University of Science and Technology, Mbarara, Uganda
| | - Amir Kabunga
- Faculty of Medicine, Lira University, Lira, Uganda
| | - Bernard Omech
- Faculty of Public Health, Lira University, Lira City, Northern, P. O Box 1035, Uganda
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Wekiya E, Mujuzi GP, Nakiyingi J, Sanya J, Matovu M, Guido O, Nakaweesi J, Karamagi C, Nakayaga JK, Mutebi EI, Nakanjako D. The clinical utility of cystatin C based eGFR in assessing renal function among HIV/AIDs patients on ART at Mildmay Uganda. BMC Nephrol 2024; 25:144. [PMID: 38654183 PMCID: PMC11036554 DOI: 10.1186/s12882-024-03581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/18/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND In clinical practice, Measurement of estimated glomerular filtration rates (eGFR) is the gold standard assessing renal function the glomerular filtration rate often estimated from plasma creatinine. Several studies have shown Cystatin C based eGFR (Cys C) to be a better parameter for the diagnosis of impaired renal function. Cystatin C based eGFR has been proposed as a potential renal function marker but its use in HIV&AIDS patients has not been well evaluated. METHODS A cross sectional study was carried out on 914 HIV&AIDS patients on antiretroviral therapy (ART) attending Mildmay Uganda for care and treatment between January to March 2015. Serum Cystatin C based eGFR was measured using the particle enhanced immunoturbidimetric assay. Creatinine was analyzed using enzymatic Creatinine PAP method and creatinine clearance was calculated according to C&G. RESULTS The sensitivity of Cystatin C based eGFR was 15.1% (95% CI = 8.4, 24) with specificity 99.3% (95% CI = 98- 99.7). The positive and negative predictive values were 70.0% (95% CI 45.7-88.1) and 91.2% (95% CI 98.11-92.94) respectively. The positive likelihood ratio was 18.81 and negative likelihood ratio was 0.85. Cystatin C based eGFR had diagnostic accuracy of 90.7 and area under curve was 0.768. CONCLUSION Cystatin C based eGFR exhibited a high specificity and a high positive likelihood ratio in diagnosis of kidney disease among HIV&AIDS patients. Cystatin C based eGFR can be used as a confirmatory test.
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Affiliation(s)
- Enock Wekiya
- Mildmay Uganda, P.O Box 24985, Kampala, Uganda.
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Godfrey P Mujuzi
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | | | | | - Moses Matovu
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Ocung Guido
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | | | - Charles Karamagi
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Joan K Nakayaga
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Edrisa I Mutebi
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Damalie Nakanjako
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
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Harris E. WHO Documents Rising Resistance to First-Line HIV Drug. JAMA 2024; 331:1355. [PMID: 38578630 DOI: 10.1001/jama.2024.4497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
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Fedurek P, Asiimwe C, Rice GK, Akankwasa WJ, Reynolds V, Hobaiter C, Kityo R, Muhanguzi G, Zuberbühler K, Crockford C, Cer RZ, Bennett AJ, Rothman JM, Bishop-Lilly KA, Goldberg TL. Selective deforestation and exposure of African wildlife to bat-borne viruses. Commun Biol 2024; 7:470. [PMID: 38649441 PMCID: PMC11035629 DOI: 10.1038/s42003-024-06139-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
Proposed mechanisms of zoonotic virus spillover often posit that wildlife transmission and amplification precede human outbreaks. Between 2006 and 2012, the palm Raphia farinifera, a rich source of dietary minerals for wildlife, was nearly extirpated from Budongo Forest, Uganda. Since then, chimpanzees, black-and-white colobus, and red duiker were observed feeding on bat guano, a behavior not previously observed. Here we show that guano consumption may be a response to dietary mineral scarcity and may expose wildlife to bat-borne viruses. Videos from 2017-2019 recorded 839 instances of guano consumption by the aforementioned species. Nutritional analysis of the guano revealed high concentrations of sodium, potassium, magnesium and phosphorus. Metagenomic analyses of the guano identified 27 eukaryotic viruses, including a novel betacoronavirus. Our findings illustrate how "upstream" drivers such as socioeconomics and resource extraction can initiate elaborate chains of causation, ultimately increasing virus spillover risk.
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Affiliation(s)
- Pawel Fedurek
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, FK9 4LA, UK
- Budongo Conservation Field Station, PO Box 362, Masindi, Uganda
| | | | - Gregory K Rice
- Biological Defense Research Directorate, Naval Medical Research Command, Fort Detrick, MD, 21702, USA
- Leidos, 1750 Presidents St, Reston, VA, 20190, USA
| | | | - Vernon Reynolds
- Budongo Conservation Field Station, PO Box 362, Masindi, Uganda
- School of Anthropology, University of Oxford, 51/53 Banbury Road, Oxford, OX2 6PE, UK
| | - Catherine Hobaiter
- Budongo Conservation Field Station, PO Box 362, Masindi, Uganda
- School of Psychology and Neuroscience, University of St Andrews; St Mary's Quad, South Street, St Andrews, KY16 9JP, UK
| | - Robert Kityo
- Department of Zoology, Entomology & Fisheries Sciences, Makerere University, PO Box 7062, Kampala, Uganda
| | | | - Klaus Zuberbühler
- Budongo Conservation Field Station, PO Box 362, Masindi, Uganda
- School of Psychology and Neuroscience, University of St Andrews; St Mary's Quad, South Street, St Andrews, KY16 9JP, UK
- Institute of Biology, University of Neuchâtel, Rue Emile-Argand 11, CH-2000, Neuchâtel, Switzerland
| | - Catherine Crockford
- Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, 04103, Leipzig, Germany
- Institut des Sciences Cognitives, 67 Bd Pinel, 69500, Bron, France
| | - Regina Z Cer
- Biological Defense Research Directorate, Naval Medical Research Command, Fort Detrick, MD, 21702, USA
| | - Andrew J Bennett
- Biological Defense Research Directorate, Naval Medical Research Command, Fort Detrick, MD, 21702, USA
- Leidos, 1750 Presidents St, Reston, VA, 20190, USA
| | - Jessica M Rothman
- Department of Anthropology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA
| | - Kimberly A Bishop-Lilly
- Biological Defense Research Directorate, Naval Medical Research Command, Fort Detrick, MD, 21702, USA
| | - Tony L Goldberg
- School of Veterinary Medicine, Department of Pathobiological Sciences, University of Wisconsin-Madison, 1656 Linden Drive, Madison, WI, USA.
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Wang JS, Xue K, Li Z, Ssempebwa J, Wamuyu-Maina G, Musinguzi G, Rhoads J, Hoisington D, Tang L. Peanut supplementation affects compositions and functions of gut microbiome in Ugandan children. Food Funct 2024; 15:4365-4374. [PMID: 38545932 DOI: 10.1039/d3fo04645a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Childhood malnutrition remains a serious global health concern, particularly in low-income nations like Uganda. This study investigated the impact of peanut supplementation on the compositions and functions of gut microbiome with nutritional improvement. School children aged 6-9 years from four rural communities were recruited, with half receiving roasted peanut snacks while the other half served as controls. Fecal samples were collected at the baseline (day 0), day 60, and day 90. Microbial DNA was extracted, and 16S rRNA sequencing was performed, followed by the measurement of SCFA concentration in fecal samples using UHPLC. Alpha and beta diversity analyses revealed significant differences between the control and supplemented groups after 90 days of supplementation. Leuconostoc lactis, Lactococcus lactis, Lactococcus garvieae, Eubacterium ventriosum, and Bacteroides thetaiotaomicron, associated with the production of beneficial metabolites, increased significantly in the supplemented group. Acetic acid concentration also increased significantly. Notably, pathogenic bacteria, including Clostridium perfringens and Leuconostoc mesenteroides, were decreased in the supplemented group. The study indicates the potential of peanut supplementation to modulate the gut metabolome, enrich beneficial bacteria, and inhibit pathogens, suggesting a novel approach to mitigating child malnutrition and improving health status.
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Affiliation(s)
- Jia-Sheng Wang
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, Georgia 30602, USA.
| | - Kathy Xue
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, Georgia 30602, USA.
| | - Zilin Li
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, Georgia 30602, USA.
| | - John Ssempebwa
- School of Public Health, Makerere University, Kampala, Uganda
| | | | - Geofrey Musinguzi
- Feed the Future Innovation Lab for Peanut, University of Georgia, Athens, Georgia 30602, USA
| | - Jamie Rhoads
- Feed the Future Innovation Lab for Peanut, University of Georgia, Athens, Georgia 30602, USA
| | - Dave Hoisington
- Feed the Future Innovation Lab for Peanut, University of Georgia, Athens, Georgia 30602, USA
| | - Lili Tang
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, Georgia 30602, USA.
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Amone A, Gabagaya G, Wavamunno P, Rukundo G, Namale-Matovu J, Malamba SS, Lubega I, Homsy J, King R, Nakabiito C, Namukwaya Z, Fowler MG, Musoke P. Enhanced peer-group strategies to support the prevention of mother-to-child HIV transmission leads to increased retention in care in Uganda: A randomized controlled trial. PLoS One 2024; 19:e0297652. [PMID: 38640123 PMCID: PMC11029615 DOI: 10.1371/journal.pone.0297652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/09/2024] [Indexed: 04/21/2024] Open
Abstract
INTRODUCTION Despite the scale-up of Option B+, long-term retention of women in HIV care during pregnancy and the postpartum period remains an important challenge. We compared adherence to clinic appointments and antiretroviral therapy (ART) at 6 weeks, 6, and and 24 months postpartum among pregnant women living with HIV and initiating Option B+. Women were randomized to a peer group support, community-based drug distribution and income-generating intervention called "Friends for Life Circles" (FLCs) versus the standard of care (SOC). Our secondary outcome was infant HIV status and HIV-free survival at 6 weeks and 18 months postpartum. METHODS Between 16 May 2016 and 12 September 2017, 540 ART-naïve pregnant women living with HIV at urban and rural health facilities in Uganda were enrolled in the study at any gestational age. Participants were randomized 1:1 to the unblinded FLC intervention or SOC at enrolment and assessed for adherence to the prevention of mother-to-child HIV transmission (PMTCT) clinic appointments at 6 weeks, 12, and 24 months postpartum, self-reported adherence to ART at 6 weeks, 6 and 24 months postpartum and supported by plasma HIV-1 RNA viral load (VL) measured at the same time points, retention in care through the end of study, and HIV status and HIV-free survival of infants at 18 months postpartum. The FLC groups were formed during pregnancy within 4 months of enrollment and held monthly meetings in their communites, and were followed up until the last group participant reached 24 months post delivery. We used Log-rank and Chi-Square p-values to test the equality of Kaplan-Meier survival probabilities and hazard rates (HR) for failure to retain in care for any reason by study arm. RESULTS There was no significant difference in adherence to PMTCT clinic visits or to ART or in median viral loads between FLC and SOC arms at any follow-up time points. Retention in care through the end of study was high in both arms but significantly higher among participants randomized to FLC (86.7%) compared to SOC (79.3%), p = 0.022. The adjusted HR of visit dropout was 2.4 times greater among participants randomized to SOC compared to FLC (aHR = 2.363, 95% CI: 1.199-4.656, p = 0.013). Median VL remained < 400 copies/ml in both arms at 6 weeks, 6, and 24 months postpartum. Eight of the 431 infants tested at 18 months were HIV positive (1.9%), however, this was not statistically different among mothers enrolled in the FLC arm compared to those in the SOC arm. At 18 months, HIV-free survival of children born to mothers in the FLC arm was significantly higher than that of children born to mothers in the SOC arm. CONCLUSIONS Our findings suggest that programmatic interventions that provide group support, community-based ART distribution, and income-generation activities may contribute to retention in PMTCT care, HIV-free survival of children born to women living with HIV, and ultimately, to the elimination of mother-to-child HIV transmission (EMTCT). TRIAL REGISTRATION NCT02515370 (04/08/2015) on ClinicalTrials.gov.
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Affiliation(s)
- Alexander Amone
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Grace Gabagaya
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Priscilla Wavamunno
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Gordon Rukundo
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Joyce Namale-Matovu
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Irene Lubega
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Jaco Homsy
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Rachel King
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Clemensia Nakabiito
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Zikulah Namukwaya
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Mary Glenn Fowler
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Philippa Musoke
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
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Hiltensperger R, Ryan G, Ben-Dor IA, Charles A, Epple E, Kalha J, Korde P, Kotera Y, Mpango R, Moran G, Mueller-Stierlin AS, Nixdorf R, Ramesh M, Shamba D, Slade M, Puschner B, Nakku J. Implementation of peer support for people with severe mental health conditions in high-, middle- and low-income-countries: a theory of change approach. BMC Health Serv Res 2024; 24:480. [PMID: 38637776 PMCID: PMC11027518 DOI: 10.1186/s12913-024-10990-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/14/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Stakeholder engagement is essential to the design, implementation and evaluation of complex mental health interventions like peer support. Theory of Change (ToC) is commonly used in global health research to help structure and promote stakeholder engagement throughout the project cycle. Stakeholder insights are especially important in the context of a multi-site trial, in which an intervention may need to be adapted for implementation across very different settings while maintaining fidelity to a core model. This paper describes the development of a ToC for a peer support intervention to be delivered to people with severe mental health conditions in five countries as part of the UPSIDES trial. METHODS One hundred thirty-four stakeholders from diverse backgrounds participated in a total of 17 workshops carried out at six UPSIDES implementing sites across high-, middle- and low-income settings (one site each in India, Israel, Uganda and Tanzania; two sites in Germany). The initial ToC maps created by stakeholders at each site were integrated into a cross-site ToC map, which was then revised to incorporate additional insights from the academic literature and updated iteratively through multiple rounds of feedback provided by the implementers. RESULTS The final ToC map divides the implementation of the UPSIDES peer support intervention into three main stages: preparation, implementation, and sustainability. The map also identifies three levels of actors involved in peer support: individuals (service users and peer support workers), organisations (and their staff members), and the public. In the UPSIDES trial, the ToC map proved especially helpful in characterising and distinguishing between (a) common features of peer support, (b) shared approaches to implementation and (c) informing adaptations to peer support or implementation to account for contextual differences. CONCLUSIONS UPSIDES is the first project to develop a multi-national ToC for a mental health peer support intervention. Stakeholder engagement in the ToC process helped to improve the cultural and contextual appropriateness of a complex intervention and ensure equivalence across sites for the purposes of a multi-site trial. It may serve as a blueprint for implementing similar interventions with a focus on recovery and social inclusion among people with mental ill-health across diverse settings. TRIAL REGISTRATION ISRCTN26008944 (Registration Date: 30/10/2019).
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Affiliation(s)
| | - Grace Ryan
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Inbar Adler Ben-Dor
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Ellen Epple
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Palak Korde
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Yasuhiro Kotera
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Richard Mpango
- Butabika National Referral Hospital, Kampala, Uganda
- Department of Mental Health, School of Health Sciences, Soroti University, Soroti, Uganda
| | - Galia Moran
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | | | - Rebecca Nixdorf
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mary Ramesh
- Department of Health Systems Impact Evaluation and Policy, Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - Donat Shamba
- Department of Health Systems Impact Evaluation and Policy, Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Health and Community Participation Division, Nord University, Namsos, Norway
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Juliet Nakku
- Butabika National Referral Hospital, Kampala, Uganda
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Nakalega R, Nabisere-Arinaitwe R, Mukiza N, Kuteesa CN, Mawanda D, Natureeba P, Kasirye R, Nakabiito C, Nabakooza J, Mulumba E, Nabukeera J, Ggita J, Kakuru A, Atuyambe L, Musoke P, Fowler MG, Lukyamuzi Z. Attitudes and perceptions towards developing a health educational video to enhance optimal uptake of malaria preventive therapy among pregnant women in Uganda: a qualitative study involving pregnant women, health workers, and Ministry of health officials. BMC Health Serv Res 2024; 24:484. [PMID: 38637742 PMCID: PMC11027371 DOI: 10.1186/s12913-024-10944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Malaria in pregnancy remains a major global public health problem. Intermittent prophylaxis treatment of malaria in pregnancy with Sulphadoxine-pyrimethamine and co-trimoxazole is efficacious for prevention of malaria in pregnancy HIV negative and positive women, respectively. However, uptake of the recommended doses of therapies has remained suboptimal in Uganda, majorly due to inadequate knowledge among pregnant women. Therefore, this study aimed to explore attitudes and perceptions towards developing an educational video for malaria preventive therapy. METHODS We conducted an exploratory study with qualitative methods among pregnant women attending antenatal care at Kisenyi Health Center IV (KHCIV), health workers from KHCIV, and officials from the Ministry of Health. The study was conducted at KHCIV from October 2022 to March 2023. Focus group discussions (FGD) were conducted among purposively selected pregnant women and key informant interviews (KII) among health workers and Ministry of Health officials. Data were analyzed using inductive and deductive thematic methods in atlas ti.8. RESULTS A total of five FGDs comprising of 7-10 pregnant women were conducted; and KIIs were conducted among four mid-wives, two obstetricians, and two Ministry of Health officials. Generally, all respondents mentioned a need for interventions to improve malaria preventive knowledge among pregnant women; were positive about developing an educative video for malaria preventive therapy in pregnancy; and suggested a short, concise, and edutaining video focusing both the benefits of taking and risks of not taking malaria preventive therapy. They proposed that women may be encouraged to view the video as soon as they conceive and throughout the pregnancy. It also was suggested that the video may be viewed on television sets in maternal and reproductive health clinics and homes, and on smart phones. CONCLUSION Pregnant women, health workers, and Ministry of Health officials were positive about the development of a short edutaining video on malaria preventive therapy that focuses on both benefits of taking and risks of not taking the malaria preventive therapy in pregnancy. This information guided the video development and therefore, in the development of health educative videos, client and stakeholder inputs may always be solicited.
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Affiliation(s)
- Rita Nakalega
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda.
| | | | | | | | - Denis Mawanda
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Paul Natureeba
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Ronnie Kasirye
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Clemensia Nakabiito
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | | | - Emmie Mulumba
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Josephine Nabukeera
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Joseph Ggita
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Philippa Musoke
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | | | - Zubair Lukyamuzi
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
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Twinomujuni SS, Atukunda EC, Mukonzo JK, Nicholas M, Roelofsen F, Ogwang PE. Evaluation of the effects of Artemisia Annua L. and Moringa Oleifera Lam. on CD4 count and viral load among PLWH on ART at Mbarara Regional Referral Hospital: a double-blind randomized controlled clinical trial. AIDS Res Ther 2024; 21:22. [PMID: 38627722 PMCID: PMC11020329 DOI: 10.1186/s12981-024-00609-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Initiation of ART among people living with HIV (PLWH) having a CD4 count ≤ 350cells/µl, produces poor immunological recovery, putting them at a high risk of opportunistic infections. To mitigate this, PLWH on ART in Uganda frequently use herbal remedies like Artemisia annua and Moringa oleifera, but their clinical benefits and potential antiretroviral (ARV) interactions remain unknown. This study examined the impact of A. annua and M. oleifera on CD4 count, viral load, and potential ARV interactions among PLWH on ART at an HIV clinic in Uganda. METHODS 282 HIV-positive participants on antiretroviral therapy (ART) with a CD4 count ≤ 350cells/µl were randomized in a double-blind clinical trial to receive daily, in addition to their routine standard of care either; 1) A. annua leaf powder, 2) A. annua plus M. oleifera, and 3) routine standard of care only. Change in the CD4 count at 12 months was our primary outcome. Secondary outcomes included changes in viral load, complete blood count, and ARV plasma levels. Participants were followed up for a year and outcomes were measured at baseline, 6 and 12 months. RESULTS At 12 months of patient follow-up, in addition to standard of care, administration of A. annua + M. oleifera resulted in an absolute mean CD4 increment of 105.06 cells/µl, (p < 0.001), while administration of A. annua plus routine standard of care registered an absolute mean CD4 increment of 60.84 cells/µl, (p = 0.001) compared to the control group. The A. annua plus M. oleifera treatment significantly reduced viral load (p = 0.022) and increased platelet count (p = 0.025) and white blood cell counts (p = 0.003) compared to standard care alone, with no significant difference in ARV plasma levels across the groups. CONCLUSION A combination of A. annua and M. oleifera leaf powders taken once a day together with the routine standard of care produced a significant increase in CD4 count, WBCs, platelets, and viral load suppression among individuals on ART. A. annua and M. oleifera have potential to offer an affordable alternative remedy for managing HIV infection, particularly in low-resource communities lacking ART access. TRIAL REGISTRATION ClinicalTrials.gov NCT03366922.
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Affiliation(s)
- Silvano S Twinomujuni
- Department of Pharmacy, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.
| | - Esther C Atukunda
- Department of Pharmacy, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Jackson K Mukonzo
- Department of Pharmacology and Therapeutics, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Musinguzi Nicholas
- Department of Pharmacy, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Felicitas Roelofsen
- Action for Natural Medicine in the Tropics (ANAMED INTERNATIONAL), Winnenden, Germany
| | - Patrick E Ogwang
- Department of Pharmacy, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
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