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PubMed2006

Trends in antenatal HIV prevalence in urban Uganda associated with uptake of preventive sexual behaviour.

BACKGROUND: Epidemiological surveillance in Uganda has consistently shown declining HIV prevalence particularly among young antenatal women since the early 1990s, correlated with increased uptake of protective sexual behaviour. OBJECTIVE: To describe trends in sexual behaviour nationwide and antenatal HIV prevalence from urban sentinel sites in Uganda (1989-2002). METHODS: Review of antenatal HIV seroprevalence data from the sentinel surveillance system (1989-2002) and data on sexual behavioural indicators from the AIDS module of the National Demographic and Health Surveys (1989, 1995 and 2000/01). Trends in biological and behavioural indicators assessed. RESULTS: Antenatal HIV seroprevalence in seven urban clinics peaked around 1992 (15-30%) followed by a steady decline by 2002 (5-12%), most markedly among women aged 15-19 and 20-24 years. This coincided with increased primary and secondary abstinence among young people nationwide. Median age at sexual debut increased from 16.5 in 1989 to 17.3 in 2000 for women and from 17.6 in 1995 to 18.3 in 2000 for men. Premarital sex among women and multiple partnerships decreased between 1995 and 2000. There were no significant changes in reporting of extramarital sex among men. Ever use of condoms increased from 1% among women in 1989 and 16% among men in 1995 to 16% and 40% in 2000, respectively. Between 1995 and 2000, condom use at last sex with a non-regular partner increased from 35% to 59% and 20% to 39% among men and women, respectively. CONCLUSION: The ecological correlation between the trends in HIV prevalence and incidence and the increase in protective sexual behaviour during the 1990s makes a compelling case for continuing prevention efforts in Uganda.

Adolescent↗
PubMed2005

The validity of DSM-IV dissociative disorders categories in south-west Uganda.

There is little systematic research on the cross-cultural validity of the dissociative disorders, especially in non-western countries. This study evaluates the fit of the DSM-IV classification and concepts of these disorders with local concepts, experiences and local presentations in south-west Uganda. We conducted focus group discussions with medical students, traditional healers, religious leaders, counselors, community members and other health workers (n=48). They were supplemented by key informant interviews with religious people, traditional healers and leaders (n=11). The responses were subjected to thematic analysis. Dissociative amnesia and depersonalization were generally recognized and seen as the result of traumatic experiences and were useful categories in Uganda. However, dissociative fugue did not match local concepts and was confused with spirit possession and other conditions such as alcoholic fugues and dementia. The description of dissociative identity disorder was always interpreted as a possession trance disorder by the local healers. We found only partial support for the validity of the DSM-IV classification of dissociative disorders in Uganda.

Adult↗
PubMed2006

Helicobacter pylori and cancer among adults in Uganda.

Data from Africa on infection with Helicobacter pylori (H. pylori) are sparse. Therefore, as part of an epidemiological study of cancer in Uganda, we investigated the prevalence and determinants of antibodies against H. pylori among 854 people with different cancer types and benign tumours. Patients were recruited from hospitals in Kampala, Uganda, interviewed about various demographic and lifestyle factors and tested for antibodies against H. pylori. In all patients combined, excluding those with stomach cancer (which has been associated with H. pylori infection), the prevalence of antibodies was 87% (723/833) overall, but declined with increasing age (p = 0.02) and was lower among people who were HIV seropositive compared to seronegative (p < 0.001). Otherwise, there were few consistent epidemiological associations. Among those with stomach cancer, 18/21 (86%) had anti-H. pylori antibodies (odds ratio 0.8, 95% confidence intervals 0.2-2.9, p = 0.7; estimated using all other patients as controls, with adjustment for age, sex and HIV serostatus). No other cancer site or type was significantly associated with anti-H. pylori antibodies. The prevalence of H. pylori reported here is broadly in accord with results from other developing countries, although the determinants of infection and its' role in the aetiology of gastric cancer in Uganda remain unclear.

Journal Article↗
PubMed2006

Was the "ABC" approach (abstinence, being faithful, using condoms) responsible for Uganda's decline in HIV?

BACKGROUND TO THE DEBATE: Uganda is one of the few African countries where rates of HIV infection have fallen, from about 15 percent in the early 1990s to about five percent in 2001. At the end of 2005, UNAIDS estimated that 6.7 percent of adults were infected with the virus. The reasons behind Uganda's success have been intensely studied in the hope that other countries can emulate the strategies that worked. Some researchers credit the success to the Ugandan government's promotion of "ABC behaviors"--particularly abstinence and fidelity. Uganda receives funds from the United States President's Emergency Plan for AIDS Relief, which promotes the ABC approach with a focus on abstinence-driven public health campaigns. Other researchers question whether the ABC approach was really responsible for the decline in HIV infection. Critics of the ABC approach also argue that by emphasizing abstinence over condom use, the approach leaves women at risk of infection, because in many parts of the world women are not empowered to insist on abstinence or fidelity.

Condoms↗
PubMed1995

Causes of childhood blindness in east Africa: results in 491 pupils attending 17 schools for the blind in Malawi, Kenya and Uganda.

Pupils attending 12 schools for the blind in Malawi, 3 schools in Kenya and 2 schools in Uganda were examined to determine the causes of severe visual impairment or blindness (visual acuity in the better eye of less than 6/60). A total of 491 pupils aged 3-22 years was examined. Visual acuity was measured in each eye using a Snellen E chart. The anatomical site of abnormality and underlying cause of visual loss were determined by clinical examination for each eye, and for the child. Information was recorded on a standard reporting form (the WHO/PBL Eye Examination Record for Children with Blindness and Low Vision). Data were analysed for those aged less than 16 years using a database which accompanies the form. Preventable and treatable causes were identified. 260 pupils aged 5-20 years were examined in Malawi, 163 pupils aged 3-19 years were examined in Kenya and 68 pupils aged 6-22 years were examined in Uganda. Of the 491 students included in the study 309 (62.9%) were blind (BL) and 69 (14.1%) were severely visually impaired (SVI). 244 were aged less than 16 years and had SVI/BL. In these 244 children 35.2% of visual loss was due to corneal pathology, 13.5% was due to cataract and 14.8% to diseases of the retina. Corneal pathology, attributed to vitamin A deficiency and measles infection in the majority, was responsible for proportionally more SVI/BL in students in Malawi than in Uganda or Kenya.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Spatial analysis of sleeping sickness, southeastern Uganda, 1970-2003.

Sleeping sickness re-emerged in southeastern Uganda in the 1970s and remains a public health problem. It has continued to spread north into new districts, and gaps remain in the understanding of the causes of its spread and distribution. We report the distribution and magnitude of sleeping sickness in southeastern Uganda from 1970 to 2003. Data were collected from records of the Ugandan Ministry of Health, individual sleeping sickness treatment centers, and interviews with public health officials. Data were used to develop incidence maps over time, conduct space-time cluster detection analyses, and develop a velocity vector map to visualize spread of sleeping sickness over time in southeastern Uganda. Results show rapid propagation of sleeping sickness from its epicenter in southern Iganga District and its spread north into new districts and foci.

Animals↗
PubMed2000

Human IgG subclass antibodies to the 19 kilodalton carboxy terminal fragment of Plasmodium falciparum merozoite surface protein 1 (MSP1(19)) and predominance of the MAD20 allelic type of MSP1 in Uganda.

OBJECTIVE: To determine the natural human humoral immune responses to the 19 kilodalton carboxy terminal fragment of Plasmodium falciparum merozoite surface protein 1 (MSP1(19)), a malaria candidate vaccine antigen and to determine the prevalence of MAD20 and K1 alleles of P. falciparum MSP1. DESIGN: Community based cross-sectional study. SETTING: Atopi Parish, Apac District, Uganda, 1995. SUBJECTS: Three hundred and seventy four Ugandans between <1 and 70 years old provided serum samples. MAIN OUTCOME MEASURES: IgG subclass antibodies by ELISA; MAD20 and K1 allelic types of MSP1 by PCR. RESULTS: Both the prevalence and the mean concentration of serum IgG1, and to a lesser extent IgG3, antibodies increased with age. IgG2 or IgG4 antibodies were virtually nonexistent. The cross-reactivity between the 4 sequence variants (E-KNG, E-TSR, Q-KNG and Q-TSR) of MSP1(19) was confirmed; however, a minority of sera preferentially recognised the KNG but not the TSR variants. All 33 P. falciparum isolates from different parts of Uganda carried the E-TSR (Mad20) allelic type and 3 isolates were mixed infections with E-TSR (MAD20) and Q-KNG (K1) allelic types, confirming the rarity of the K1 allele in Uganda. CONCLUSION: There is a robust IgG1 antibody response to the malaria vaccine candidate antigen MSP1(19) which begins at an early age. Future cohort studies are necessary to estblish the impact of these antibodies on clinical immunity to malaria. The MAD20 allelic type of MSP1 id predominant in Ugandan P. falciparum isolates.

Animals↗
PubMed2002

Resistance patterns of Plasmodium falciparum malaria to chloroquine in Kampala, Uganda.

BACKGROUND: Chloroquine is a first line drug for the treatment of uncomplicated Plasmodium falciparum malaria in Uganda. Recently, there have been increasing reports of resistance of Plasmodium falciparum malaria to chloroquine, as well as an increase in malaria morbidity and mortality among adults and children. OBJECTIVES: To assess the current effectiveness (clinical and parasitological response) of chloroquine in the treatment of uncomplicated Plasmodium falciparum malaria, and to define the magnitude of chloroquine resistant Plasmodium falciparum malaria in Kampala. DESIGN: A descriptive cross-sectional study among adults and children. SETTING: Mulago hospital complex (the national referral and teaching hospital in Kampala, Uganda) between September 1998 and March 1999. RESULTS: Ninety six patients with Plasmodiumfalciparum parasitaemia of 1000 to 100,000/microl of blood were treated with oral chloroquine phosphate, and followed up for 14 days. Sixty three (65.6%) patients showed clinical improvement, 29 (30.2%) deteriorated and four (4.2%) had no change. Adequate parasitological response was seen in 71(74 %), moderate in four (4.2%) and poor in 21(21.8%) patients. Treatment failures were highest among children below five years, with eleven (57.9%) children not responding to chloroquine. CONCLUSION: Although chloroquine was found to be effective in two thirds of all patients, the high treatment failure, especially seen in children below five years is of concern. This necessitates further countrywide studies, and possibly a need to review the use of chloroquine as single first line drug for the treatment of uncomplicated malaria in Uganda, especially in children below five years of age.

Adolescent↗
PubMed2004

Immunohistochemical analysis of Hodgkin's disease in Kampala, Uganda.

BACKGROUND: Histopathological examination remains crucial for diagnosis and classification of Hodgkin's disease (HD) but poses problems when characteristic features of HD are not present and hence the value of immunohistochemistry. Experience with immunohistochemistry in developing countries is limited due to cost. OBJECTIVE: To describe the immunophenotypic and histologic types of Hodgkin's disease in Kampala, Uganda DESIGN: A cross-sectional study. SETTING: Makerere University Medical School, Department of Pathology. METHODOLOGY: Two hundred formalin fixed, paraffin- embedded biopsies, which had been previously diagnosed as Hodgkin's disease in the Makerere University, Department of Pathology from 1980--2000, were re-assessed with haematoxylin and eosin. The sections were then subjected to immunohistochemistry using monoclonal antibodies: leucocyte common antigen (CD45), antibodies to Reed-Sternberg cells (CD15, CD30) and to B cells (CD20). RESULTS: Of the 200 biopsies, 171 (71.3%) were diagnosed as Hodgkin's disease using immunohistochemistry. The mean age of the 171 cases was 26.1(SD 16.2) years; mode 20.0; median 22.5 years. The 15-24 year age group was most affected (47.2%). There were more males (65.9%) than females and most were Baganda who are the main tribe in the central region of Uganda. Mixed cellularity (35.7 %) and lymphocyte depleted (24.6 %) HD were the commonest histological types. Classic HD (CD30, CD 15, CD20, CD45) was the most commonest (77.8%) immunophenotype. CONCLUSION: Classic Hodgkin's disease (CD30, CD 15, CD20 and CD45) is the most commonest immunophenotype in Kampala, Uganda, and mixed cellularity and Iymphocyte depleted are the main histologic subtypes.

Adolescent↗
PubMed2005

Papillary squamous cell carcinoma of the cervix in Uganda: a report of 20 cases.

BACKGROUND: Non-glandular papillary carcinoma of the cervix are uncommon tumours. In Uganda where cervical carcinoma is very common, no cases of papillary squamous cell carcinoma of the cervix has been reported. OBJECTIVES: To ascertain the occurrence and describe the clinicopathological features of papillary squamous cell carcinoma of the cervix in Uganda. STUDY DESIGN: Retrospective review of histologically diagnosed cases of squamous cell carcinoma of cervix with papillary structures. METHODS: Retrospective review of cases of cervical carcinoma diagnosed in the Pathology Department, Makerere University from 1968 to 1973 was done. Cases with features of squamous differentiation and forming papillary pattern were then selected. RESULTS: Twenty cases were encountered and the ages of the patients ranged from 22 to 70 years (mean 46.6 years). Histologically, the tumours had thin to broad fibrovascular cores covered by multilayered squamous epithelium. In five cases, there were areas with very delicate fibrovascular cores covered by monolayered epithelial cells. CONCLUSION: The results of this study show that in Uganda, papillary squamous cell carcinoma of the cervix does occur and is predominantly a disease of older women. The results also confirm that papillary squamous cell carcinoma is a distinct subtype with some variants, and support the hypothesis that squamous cell carcinoma of the cervix is heterogeneous group of tumuors.

Adult↗
PubMed2006

Burden of alcohol use in the Uganda Police in Kampala District.

BACKGROUND: Alcohol dependence is one of the leading causes of the global burden of disease. Among members of the Uganda Police Force, alcohol dependence has been a major contributor of poor mental health, poor work output and forced retirement. OBJECTIVE: This study was carried out to determine the prevalence of alcohol dependence and associated psychosocial problems in the Uganda Police Force in Kampala District. METHODS OF STUDY: A sample of police officers selected by systematic sampling strategy from two large barracks in Kampala District participated. A semi-structured questionnaire designed to elicit information on the perceived impact of alcohol use was used. Prevalence rate was derived from ICD-10 criteria for alcohol dependence, and psychosocial problems in alcohol dependence. RESULTS: Twenty respondents (19.2%) met criteria for alcohol use disorder, 26.0% met criteria for alcohol use problems and 9.6% reported that their health was poor. Alcohol use disorder or problems were significantly associated with lack of job satisfaction, poor health, problems in implementing personal plans, disciplinary problems, inability to save from personal earnings, debts, and absenteeism from work. CONCLUSION: One in five police officers met criteria for alcohol use disorder while one in four experienced psychosocial problems related to alcohol use. The results suggest serious implications for the quality of services provided by the Uganda Police. There is a need to establish measures to provide services for those affected, and a further need to establish preventative measures against alcohol dependence in the police force.

Adult↗
PubMed2006

Cholera in endemic districts in Uganda during El Niño rains: 2002-2003.

BACKGROUND: El Niño phenomenon causing increased rainfall and flooding has been linked to flare ups and emergence of several disease outbreaks including cholera. The latter has been reported in many districts in Uganda in recent years. Therefore an understanding of factors influencing its pattern of occurrence is needed for effective control. OBJECTIVES: To determine cholera disease status during six months of El Niño rains and assess serotypes and antibiotic sensitivity of isolates. METHODS: A prospective study was conducted in five cholera "endemic districts" in Uganda. RESULTS: Cholera outbreaks occurred in all the study districts coincident with the onset of the El Niño rains. There were 924 cholera suspect cases reported with 95 fatalities (case fatality rate 10.3%). A total of 388 clinical specimens were analyzed by culture and of these, 168 were positive for V. cholerae. Biochemical and serological analysis identified the isolates as V. cholerae O1, biotype EL Tor serotype Ogawa. Antibiotic sensitivity revealed that isolates were 100% sensitive to ciprofloxacin, tetracycline and erythromycin, whereas sensitivity was variable for other tested antibiotics. Unlike Kampala, where the disease was contained within three months, persistence occurred in other districts only dying out with end of El Niño rains, suggesting differences in disease control. CONCLUSION: These results show that El Niño rains cause increase in the number of cholera cases in Uganda, calling for preparedness and a need to emulate Kampala response incase of outbreaks in other districts.

Cause of Death↗
PubMed2005

Further observations on the blood parasites of birds in Uganda.

Birds from three National Parks (Bwindi Impenetrable, Kibale, and Queen Elizabeth) in western Uganda were surveyed during the dry season in July 2003 and investigated for hematozoa by microscopic examination of stained blood films. Of 307 birds examined, representing 68 species of 15 families and four orders, 61.9% were found to be infected with blood parasites. Species of Haemoproteus (15.3% prevalence), Plasmodium (20.5%), Leucocytozoon (40.1%), Trypanosoma (11.4%), Hepatozoon (2.6%), Atoxoplasma (0.3%), and microfilariae (3.9%) were recorded. Except for Haemoproteus spp. infections, the overall prevalence of hematozoa belonging to all genera was significantly higher in this study than was previously reported in Uganda. Thirty-six species of birds were examined for blood parasites for the first time and 112 new host-parasite associations were identified. Eighty-one were at the generic and 31 at the specific level of the hematozoa. Hepatozoon and Atoxoplasma spp. were detected for the first time in Uganda.

Animals↗
PubMed1999

Tsetse and trypanosomiasis control problems in south-east Uganda: past, present and alternative strategies.

Tsetse and trypanosomiasis in South-East Uganda are reviewed. This paper examines why in nearly 100 years no appreciable progress has been made in tsetse and trypanosomiasis control. It points out that tsetse control strategies in the past have relied on sophisticated technologies such as aerial spraying, which are inappropriate to Uganda's economic and environmental situation. With the vector, G. f. fuscipes, being peridomestic and the transmission cycle undoubtedly domestic animal-fly-man, community participation using appropriate technologies such as low-cost traps/targets and integrating farming activity with tsetse control seem to be the most appropriate approach in South-East Uganda. Savings in expenditure on vector control are discussed in light of diminishing resources.

Animals↗
PubMed1999

Anti-tuberculosis drug resistance surveillance in Uganda 1996-1997.

SETTING: Drug resistance surveillance conducted by the National Tuberculosis and Leprosy Control Programme (NTLP) Uganda from 1996-1997 in collaboration with the Armauer Hansen Institute/German Leprosy Relief Association (GLRA), Germany, for the WHO/IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance. OBJECTIVE: To determine the prevalence of primary and acquired anti-tuberculosis drug resistance in Uganda. DESIGN: The survey area covered three GLRA-supported operational NTLP zones, corresponding to 50% of the Ugandan population. A representative random sampling of individual patients was chosen as sampling procedure. Altogether 586 smear-positive TB patients (537 new cases and 49 previously treated cases) were included in the survey. RESULTS: For primary resistance the results were as follows: isoniazid (H) 6.7%, rifampicin (R) 0.8%, ethambutol (E) 6.1%, streptomycin (S) 13.4%, thioacetazone (T) 3.2%, pyrazinamide (Z) 0%, multidrug resistance (MDR) 0.5%; for acquired resistance they were: H 37.8%, R 4.4%, S 22.2%, E 11.1%, T 20.0%, Z 0%, and MDR 4.4%. CONCLUSION: According to these data the NTLP Uganda has been effective in preventing high levels of primary drug resistance. If it is assumed that the sampling process reflects the distribution of new patients and previously treated patients in the study areas, the amount of acquired resistance (any resistance) in the community of smear-positive patients is approximately 5%. To further monitor programme performance the NTLP will embark on a nationwide survey in 1998/1999.

Adolescent↗
PubMed1998

Legislatory framework for private medical practice in Uganda.

BACKGROUND: In Uganda the private health sector has expanded dramatically in recent years with a striking proliferation of facilities for private medical practice which is particularly evident in urban areas. OBJECTIVES: The general objective of this study was to analyse the laws and regulations governing the private health sector in order to determine how they affect the operations and development of private medical practice in Uganda. METHODS: Between December 1995 and December 1996, we identified and reviewed all the laws, which affect private medical practice in Uganda. We discussed the contents of the laws with Ministry of Health officials and with representatives of private practitioners. We also made visits to a sample of clinics, which we inspected to ascertain compliance with the laws, and held interviews with managers of the clinics to get their views about the laws. RESULTS: Two categories of laws were identified. The first category includes two laws adopted in 1993, whose purpose is to ensure the availability at all times of efficacious and cost effective drugs in the country. The second category includes three laws, all adopted in 1996, which spell out the licensing procedures, supervision, disciplining and general control of different categories of professionals. The list of health professions, which are permitted to practice privately, was revised to include new categories, which were previously not allowed. We identified what we considered to be barriers to private health sector development, loopholes in the laws and also assessed the enforcement of the laws. The legal barriers include restrictions of drug imports, the requirement for the professionals to renew their practising licenses and to register the premises annually at one central place in the country, long periods of time mandated for acquiring experience before one can be permitted to practice privately and the finding that there are some capable professions which are still not allowed to practice privately. CONCLUSION: We made recommendations to the Ministry of Health to address all these barriers. We also recommended to the Ministry that non-professionals who have the ability to set up clinics should be allowed to register them provided they can engage professionals to operate them.

Cost-Benefit Analysis↗
PubMed1994

Lack of association between anti-V3 loop antibodies and perinatal transmission of HIV-1 in Kampala, Uganda.

This study evaluated the association between reactivity of maternal antibody to human immunodeficiency virus type 1 (HIV-1) V3 loop peptides and perinatal transmission in Uganda. Plasma from 40 HIV-1-infected mothers (20 transmitting and 20 nontransmitting mothers) and 31 uninfected mothers in Uganda were tested for reactivity and antibody titer to synthetic peptides representing V3 loop sequences from HIV-1 strains MN, SF2, LAI, ZR6, and CM235 and consensus peptides CA, CB, and CD. No significant differences were found between 20 transmitting mothers and 20 nontransmitting mothers in terms of percent reactivity or titer of antibody to any of the V3 loop peptides tested. Use of a multivariable logistic model to adjust for beta-2 microglobulin level as a confounding variable of stage of infection did not help demonstrate an association except possibly for the ZR6 peptide. These data suggest that neither reactivity nor maternal antibody titer to V3 loop peptides are protective against perinatal transmission of HIV-1 in Uganda.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Dental caries status of 5-7 year old children in three districts in Tanzania, Uganda and Mozambique.

This paper presents the baseline data of a longitudinal study assessing the dental caries status of 5-7 year old children in Tanzania, Uganda and Mozambique. Approximately one hundred 5-7 year-old-children from randomly selected schools in each of three locations (formal urban, informal urban and rural) were examined using the 1997 WHO Oral Health Survey Criteria. Thirty nine percent of the entire sample were found to bc caries-free, however this differed from location to location and from country to country. The overall mean dmft was 2.4 (SD 2.8), with the decayed component being 2.0 and the missing component 0.4. Of the children examined, only three had filled teeth. The mean dmft was significantly higher (p-value < 0.05) in Tanzania and Uganda than in Mozambique. There were also significant differences in the mean dmft between the various locations in Uganda and Mozambique. The prevalence of dental caries was not consistent across the formal urban, informal urban and rural locations in the three countries studied. It is thus essential to desegregate oral health status data to the most local level possible.

Child↗