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PubMed2005

Traditional healers for HIV/AIDS prevention and family planning, Kiboga District, Uganda: evaluation of a program to improve practices.

In the face of ongoing epidemics of HIV/AIDS and STI, high demand for family planning, and limited resources, traditional healers may be under-utilized providers of reproductive health education in rural sub-Saharan Africa. We implemented a training program in HIV prevention and family planning methods for healers in the Kiboga district of Uganda and evaluated the program's impact on healers' clinical practice and the diffusion of information to their female clients. Of 46 healers recruited, 30 (65%) completed a pre- and post-training interview. Following training, traditional healers increased discussions of family planning with their clients. Of 84 female clients recruited, 44 (52%) completed the interview before and after the training for healers. Female clients corroborated that they increased discussions of family planning with their healers, as well as discussions about HIV/AIDS. Both healers and their female clients were more likely to make a connection between family planning, condom use, and HIV prevention after the training compared to before the training. Findings provide evidence that traditional healers in a rural area of Uganda can successfully adapt HIV prevention messages and family planning information into their clinical practices.

Adult↗
PubMed2006

HIV counseling and testing practices at an urban hospital in Kampala, Uganda.

While the majority of medical inpatients in Uganda are assumed to be HIV-positive, HIV testing is limited in inpatient settings. This study describes HIV testing practices and risk behavior among medical inpatients at an urban hospital in Uganda. We interviewed 395 adults on the day of discharge. Overall, 46% tested for HIV before or during admission. Of the 20% tested during hospitalization, 64% were HIV-positive. Among 47% who had sex in the previous year, only 14% used condoms consistently and only 20% knew the HIV status of their sexual partner, indicating that participants would benefit from risk-reduction counseling. Yet, only 26% of participants tested during hospitalization received post-test counseling. Half of the participants with HIV-related illnesses left the hospital without being offered the test, a missed opportunity for HIV prevention counseling and care. The findings indicate that hospitals are important venues for HIV counseling and testing.

Adolescent↗
PubMed2006

Uganda's HIV prevention success: the role of sexual behavior change and the national response.

There has been considerable interest in understanding what may have led to Uganda's dramatic decline in HIV prevalence, one of the world's earliest and most compelling AIDS prevention successes. Survey and other data suggest that a decline in multi-partner sexual behavior is the behavioral change most likely associated with HIV decline. It appears that behavior change programs, particularly involving extensive promotion of "zero grazing" (faithfulness and partner reduction), largely developed by the Ugandan government and local NGOs including faith-based, women's, people-living-with-AIDS and other community-based groups, contributed to the early declines in casual/multiple sexual partnerships and HIV incidence and, along with other factors including condom use, to the subsequent sharp decline in HIV prevalence. Yet the debate over "what happened in Uganda" continues, often involving divisive abstinence-versus-condoms rhetoric, which appears more related to the culture wars in the USA than to African social reality.

Acquired Immunodeficiency Syndrome↗
PubMed2006

The Babel effect: community linguistic diversity and extramarital sex in Uganda.

We examine the association of community linguistic diversity with non-spousal sexual activity in Uganda. We conducted a survey on rates of sexual contact in last 12 months among 1709 respondents age 18-60 living in Uganda in early 2001. Households were selected at random from Demographic and Health Survey (DHS) 2000 household sampling frame listings in 12 districts and 120 clusters. Household listings described the principal language spoken by every household in the cluster. Sexual contact was reported by 26 vs. 13% of unmarried women in multilingual vs. monolingual clusters respectively. Extramarital sexual contact occurred for 29 vs. 16% for married men in multilingual vs. monolingual clusters respectively. These results were robust to multivariate models which included confounders such as urbanity, and cluster distance to market places, cinemas, and transportation. Our results suggest a robust association between residence in a multilinguistic community and higher rates of non-spousal sex.

Adolescent↗
PubMed2006

Depression and CD4 cell count among persons with HIV infection in Uganda.

Despite the importance of mental illness and the high prevalence of HIV in Africa, few studies have documented depressive symptoms among HIV-infected persons in Africa. We assessed factors associated with depression among HIV-infected adults undergoing anti-retroviral eligibility screening in Eastern Uganda. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Univariate and multiple regression analyses were conducted to identify socio-demographic characteristics and disease-related factors associated with depression. Among 1017 HIV-infected participants assessed for depression, 47% (476/1017) reported depressive symptoms (CES-D >/= 23). Adjusting for age, gender, education, and source of income, patients with CD4 counts <50 cells/microl were more likely to be depressed (odds ratio 2.34, 95% confidence interval, 1.39-3.93, P = 0.001). Women, participants >50 years, and those without an income source were more likely to be depressed. Depression was common among HIV-infected persons in rural Uganda and was associated with low CD4 cell counts. Appropriate screening and treatment for depression should be considered for comprehensive HIV care.

Adolescent↗
PubMed2006

Genetic diversity and variety composition of cassava on small-scale farms in Uganda: an interdisciplinary study using genetic markers and farmer interviews.

Cassava is a tropical crop and grown for its tuberous starchy roots. In Africa it is mainly cultivated by small-scale farmers who observe, select and name their cassava varieties based on morphology, food, social and economic interest. Here we have used an interdisciplinary approach involving farmer interviews, genetic markers and morphological descriptors to study the composition of cassava varieties on small-scale farms in 11 villages located in three districts in Uganda, the genetic structure within and between these varieties and their morphology. The composition of local, newly introduced and improved varieties differed widely between villages and districts. The Ugandan farmers in our study seemed to adopt improved varieties to a greater extent when there was a nearby market, prevalence of disease epidemics and good extension service. We found considerable genetic variation both within and between cassava varieties though the variation was larger between varieties. However, most local and improved varieties showed predominating genotypes at many loci. Accessions of commonly grown varieties meeting farmers' preferences could therefore be selected and implemented in future breeding programmes involving development, dissemination and adoption. The like-named varieties in different villages were genetically similar, demonstrating farmers' ability to differentiate and maintain the same variety over large areas. However, some varieties with different names in different villages showed both genetic and morphological similarity, suggesting that farmers may rename plants when they are introduced into their fields. The large differences found in variety and genetic composition between villages and districts in Uganda may be a result of the diverse needs and growing conditions characteristic for traditional farming system. This suggests that efforts to conserve and increase the genetic diversity in farmers' fields will require policies tailored to each area.

Africa↗
PubMed2005

Strategies, effectiveness and rationale of vector-borne disease control in the pastoralist system of south-western Uganda.

In Uganda, control of vector-borne diseases is mainly in form of vector control, and chemotherapy. There have been reports that acaricides are being misused in the pastoralist systems in Uganda. This is because of the belief by scientists that intensive application of acaricide is uneconomical and unsustainable particularly in the indigenous cattle. The objective of this study was to investigate the strategies, rationale and effectiveness of vector-borne disease control by pastoralists. To systematically carry out these investigations, a combination of qualitative and quantitative research methods was used, in both the collection and the analysis of data. Cattle keepers were found to control tick-borne diseases (TBDs) mainly through spraying, in contrast with the control of trypanosomosis for which the main method of control was by chemotherapy. The majority of herders applied acaricides weekly and used an acaricide of lower strength than recommended by the manufacturers. They used very little acaricide wash, and spraying was preferred to dipping. Furthermore, pastoralists either treated sick animals themselves or did nothing at all, rather than using veterinary personnel. Oxytetracycline (OTC) was the drug commonly used in the treatment of TBDs. Nevertheless, although pastoralists may not have been following recommended practices in their control of ticks and tick-borne diseases, they were neither wasteful nor uneconomical and their methods appeared to be effective. Trypanosomosis was not a problem either in Sembabule or Mbarara district. Those who used trypanocides were found to use more drugs than were necessary.

Animal Husbandry↗
PubMed1980

Gonorrhea and female infertility in rural Uganda.

We studied sociocultural and medical factors in the Teso District in eastern Uganda and the Ankole District in western Uganda to discover the cause of the low and high fertility rates in these respective districts. The findings related to gonorrhea in women are presented in this article. Gonococcal cervicitis and clinical evidence of salpingitis occurred significantly more frequently in Teso (18.3% and 19%, respectively) than in Ankole (2.4% and 5.9%) women. Significantly more of the husbands of the gonococcal-negative infertile women compared to gonococcal-negative fertile women were found to have active gonorrhea, a past history of urethral discharge, and bilaterally thickened epididymides.

Adult↗
PubMed1976

The protective effect of BCG against Mycobacterium ulcerans disease: a controlled trial in an endemic area of Uganda.

In a BCG vaccination trial in an area of Uganda endemic for Mycobacterium ulcerans disease ("Buruli Ulcer"), 8,856 persons were examined for the disease in mid-1970 and tuberculin tested; BCG was given by intradermal injection to a random 50% of all those with negative, low or middle grade tuberculin reactions; Twelve months later the study group was re-examined for M. ulcerans lesions and, subsequently, new cases of the disease were detected, using a hospital registration system, to December 1974. One hundred and forty-nine patients with onset since July 1970 were thus ascertained and BCG was found to offer an overall protection of 47% against the disease, similar to that observed in a previous smaller trial by the Uganda Buruli Group (UBG, 1969). However, the protective effect was confined to those with tuberculin reactions of less than 4 mm before vaccination and was apparent only in the first year of the study. BCG offered no additional protection to those with previous M. ulcerans disease or an existing BCG scar at entry into the trial, although both these groups appeared to be protected against the disease, the protective effects being 88% and 82% respectively. An initial tuberculin reaction of 4 mm (or greater) offered some protection against the disease (37%). Lesions developing in the vaccinated group, or in those with initial tuberculin reactions of 4 mm or more, were smaller than those in unvaccinated persons. No relationship was found between the protective effect of BCG and either the prevalence of persons with evidence of previous M. ulcerans disease in different geographical areas, or the incidence of new cases in different areas during the first year of the study. A decline in the incidence was observed over the study period. The findings are consistent with BCG producing only short-lasting protection against M. ulcerans disease. However, long-lasting protection and a delay in onset of the disease in vaccinated persons, as suggested by the UBG in 1969, cannot be excluded on the basis of the data currently available from this trial.

Adolescent↗
PubMed1977

A comparison of the pathogenesis of protein-energy malnutrition in Uganda and The Gambia.

The pattern of growth, biochemical and endocrine development, dietary intake and disease patterns of rural children in Uganda and The Gambia have been monitored during the first three years of life in order to gain a more complete understanding of the reasons why in Uganda kwashiorkor predominates, whereas in The Gambia it is marasmus. Evidence is produced which supports the view that the hormonal balance, particularly cortisol and insulin status, can have a profound influence on which organs of the body are preferentially affected by malnutrition and hence on the type of protein-energy malnutrition which is likely to emerge. There were, however, also important differences in protein and energy intake between the two countries.

Alanine↗
PubMed1977

A yellow fever epizootic in Zika Forest, Uganda, during 1972: Part 2: Monkey serology.

During the 1972 yellow fever epizootic in Zika Forest, Uganda, sera from 21 monkeys shot in a number of forests around the Entebbe area were tested for the presence of a number of arbovirus antibodies. All sera were tested for antibodies against Chikungunya (CHIK), O'nyong-nyong (ONN), Zika, yellow fever (YF) West Nile (WN) and Wesselsbron (WESS) by the haemagglutination-inhibition (HI) test. Because of the crossreaction within the flaviviruses (group B arboviruses) mouse protection test (PT) was also carried out on the sera against YF, WESS and Zika viruses. Serological studies carried out on monkey sera from different parts of Uganda, including the Entebbe area, during 1968 gave results which reflected a surprisingly low rate of YF immune monkeys (3%) throughout the country compared with the rate of over 40% immune monkeys obtained by Haddow et al. in 1951. 40% of the monkey sera collected during 1972 were immune to YF by the PT. Since no YF virus had been isolated between 1968 and 1972 the results indicate strongly that the monkeys in the Entebbe area were involved in the epizootic of 1972. No sick or dead monkeys were found in all the forests checked around Entebbe area during the epizootic. This indicates that the animal-to-animal cycle of the equatorial African forests involved the mild endemic infection characteristic of a virus in its natural habitat and infecting its natural host.

Animals↗
PubMed1983

Isoenzyme characterization of some Trypanozoon stocks from a recent trypanosomiasis epidemic in Uganda.

The 1976-82 epidemic of human trypanosomiasis in south-east Uganda affected new foci to the north of the old endemic area bordering lake Victoria, and was associated with a different vector, Glossina fuscipes fuscipes; isoenzyme studies revealed that the epidemic involved different strains of pathogenic trypanosomes also. 58 Trypanozoon isolates from the epidemic area and from the adjoining endemic area of West Central Kenya were compared by thin-layer starch gel electrophoresis for 11 enzymes. Six different trypanosome zymodemes were circulating in man in the Ugandan epidemic, including the zymodeme found before 1976 in the old endemic area; all stocks examined from West Central Kenya belonged to this latter zymodeme. Trypanosomes identical to those found in man were found in cattle and a dog in Uganda, and in cattle in Kenya; these animals were presumably reservoir hosts of the human disease. Four isolates from triturated G. f. fuscipes collected in 1971 were identical but differed from all mammalian isolates examined.

Animals↗
PubMedDate not supplied

The clinical and parasitological presentation of Plasmodium falciparum malaria in Uganda is unaffected by HIV-1 infection.

The relation between Plasmodium falciparum malaria and symptomatic human immunodeficiency virus 1 (HIV-1) infection was investigated in paediatric and adult patients in Kampala, Uganda, from 1987 to 1989. Both infections contributed largely to hospital morbidity. Of 1527 clinically suspicious in-patients, 61% were positive for HIV-1 infection. 52% of patients with positive HIV-1 serology fulfilled the World Health Organization clinical case definition for acquired immune deficiency syndrome (AIDS) in Africa. No association could be found between HIV-1 infection and malaria either in paediatrics or in adults. P. falciparum parasitaemia was present in 18% of all patients and no differences in prevalence of malaria infection or in parasite density could be demonstrated between HIV-1 positive and HIV-1 negative patients. The comparison of clinical symptoms showed typical differences in AIDS-related morbidity but no difference in malaria-specific morbidity. Also, the response to malaria treatment was the same in HIV-1 positive and HIV-1 negative patients. P. falciparum malaria does not appear to act as an opportunistic agent in AIDS patients in Uganda.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Uganda--rehabilitation, or redefinition of health services?

Uganda had one of the best health care delivery systems in Africa. The decade of misrule by Amin saw a collapse of the country and an exodus of doctors and other professions. The 1979 liberation war and subsequent political instability and insecurity further aggravated the poor health services then available. When political stability was temporarily restored in December 1980 the cash crop export sector took priority over social services and the health budget declined to only 3.5% compared to a former level of 7.5% of government budget. Emergencies in West Nile, Karamoja and the Luwero triangle continued to plague rehabilitation efforts upto 1985. Alternate strategies for improving health are proposed including female education, increased budget allocations, food and nutrition policy and health information. Uganda's prospect for rebuilding the health services has begun with immunization, control of diarrhoeal diseases, nutrition surveillance in Karamoja and an essential drugs programme, but the success of these is dependent upon political stability and improvement in overall security.

Budgets↗
PubMed1995

An economic evaluation of alternative programme designs for tuberculosis control in rural Uganda.

Tuberculosis (TB) and AIDS are infections that are among the most feared of all diseases. Both have been widely discussed by the western media in recent months, for a variety of reasons, but it is the combination of the two diseases in an ever increasing number of patients that is causing concern to health planners and health economists. While AIDS is untreatable and prevention of further infection depends largely on changes in sexual behaviour, TB remains eminently treatable. Preventing the spread of TB depends on the effective treatment of active cases, taking 6-12 months, depending on the drugs used. In order to ensure completion of treatment, a programme of registering and following up patients is required. A number of different programme designs are considered and an analysis of both costs and consequences is attempted in order to find the most cost-effective alternative. Data from western Uganda for 1992 are used for the study and the implications of the findings for both Uganda and other African countries are discussed. It is concluded that a programme based on the ambulatory treatment of patients at their nearest health unit, whilst living at home, is the most cost-effective design, largely because of reduced costs to the patients themselves. Specific recommendations are made regarding the implementation of such a programme.

Ambulatory Care↗
PubMed2026

Lesion viral burden, multidrug-resistant superinfection, and HIV-associated haematological vulnerability in hospitalised clade Ib mpox: a prospective cohort study in Uganda.

BACKGROUND: Mpox has shifted to sustained human-to-human transmission across Africa, yet integrated triage incorporating viral burden, bacterial co-infection, antimicrobial resistance (AMR), HIV status, and routine biomarkers remain scarce. METHODS: At Uganda's national mpox referral hospital, we prospectively enrolled 155 adults at 14 &#xb1; 2 days post-symptom onset; mpox was confirmed by lesion-swab qPCR (F3L), with clade assignment by whole-genome sequencing in a prespecified subset (March-April 2025). Lesion viral DNA burden was estimated using qPCR cycle threshold (Ct) values. Purulent lesions underwent EUCAST-standardised culture and susceptibility testing. Routine laboratory assessments included complete blood counts, C-reactive protein, serum chemistries, HIV serostatus, and plasma HIV-1 RNA. FINDINGS: Median age was 30 years, and 73/155 (47%) had HIV infection. Multisite pain, particularly anogenital, was highly prevalent. Among 80 participants with purulent lesions selected for clinically suspected bacterial superinfection, all yielded bacterial growth; 35/80 (43.8%) were polymicrobial and predominantly multidrug-resistant Gram-negative bacilli. Susceptibility to first-line &#x3b2;-lactams and fluoroquinolones was low, whereas meropenem retained activity (51/61, 84%). Lesion viral burden did not differ by HIV serostatus and showed weak correlation with HIV-1 viraemia; higher burden was associated with leucocytosis, neutrophilia with left shift, elevated CRP, and hypoalbuminaemia. Genomes clustered within Clade Ib, without segregation by HIV status or clinical severity. INTERPRETATION: Hospitalised adults with acute Clade Ib mpox in Uganda exhibited high lesion viral burden, frequent multidrug-resistant bacterial co-isolation, and an inflammatory haematological profile accentuated in participants living with HIV-1. These findings support consideration of integrating diagnostic microbiology, HIV viral load assessment, and antimicrobial stewardship into mpox case-management in endemic settings. FUNDING: This study was supported by the Coalition for Epidemic Preparedness Innovations (CEPI; Project ID PRJ-8284).

Adult↗
PubMed2005

Perceptions on use of sulfadoxine-pyrimethamine in pregnancy and the policy implications for malaria control in Uganda.

In malaria endemic areas intermittent treatment with sulfadoxine-pyrimethamine (SP) is recommended for malaria prevention in pregnancy. Yet, data on perceptions regarding use of this drug are scarce. An exploratory study was conducted to assess perceptions on SP in Mukono district, Uganda. This is an initial step towards a review of the policy aimed at improving access and use of SP in pregnancy, which is currently low. Results show that SP is perceived to be an effective drug that cures malaria quickly. However there are negative perceptions related to its use in pregnancy. SP is believed to be strong and weakens pregnant women, causes abortions and foetal abnormalities. There is also a perception that resorting first to SP for malaria treatment may lead to the development of drug resistance. This perception may limit access to effective treatment of malaria in this community since the policy in Uganda recommends SP in combination with chloroquine as the first-line treatment. The policy implications of these findings include developing a health promotion package to demystify the misconceptions on the strength of SP, to explain its benefits and side-effects. This package will involve giving health workers refresher training on communication and counselling on use of SP in pregnancy targeting special groups like pregnant adolescents. These results provide important lessons to policy makers and programme managers who aim at scaling up access of SP for malaria prevention in pregnancy.

Adolescent↗
PubMed2006

The effect of storage time and agroecological zone on mould incidence and aflatoxin contamination of maize from traders in Uganda.

A study to determine mould incidence and aflatoxin contamination of maize kernels was carried out among dealers (traders) in the three agroecological zones of Uganda. The maize kernels were categorized into those stored for two to six months or for more than six months to one year. Results indicate that the mean moisture content of the kernels was within the recommended safe storage levels of < or =15% but was significantly lower in the Highland maize kernels followed by the Mid-Altitude (dry) kernels while the Mid-Altitude (moist) kernels had the highest levels. Across the agroecological zones, Aspergillus, Fusarium, Penicillium and Rhizopus were the most predominant fungal genera identified and, among their species, A. niger had the highest incidence, followed by A. flavus, F. verticillioides, A. wentii, A. penicillioides and Rhizopus stolonifer. There were more aflatoxin positive samples from the Mid-Altitude (moist) zone (88%) followed by those samples from the Mid-Altitude (dry) zone (78%) while samples from the Highland zone (69%) were least contaminated. Aflatoxin levels increased with storage time such that maize samples from the Mid-Altitude (dry and moist) stored for more than six months had mean levels greater than the 20 ppb FDA/WHO regulatory limits. Aflatoxin B1 was the most predominant type and was found to contaminate maize kernels from all the three agroecological zones. These results indicate that maize consumers in Uganda are exposed to the danger of aflatoxin poisoning. Thus, there is the need for policy makers to establish and enforce maize quality standards and regulations related to moulds and aflatoxins across the agroecological zones to minimize health hazards related to consumption of contaminated kernels.

Aflatoxins↗