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Anaplasmosis in Uganda. II. Prevalence of bovine anaplasmosis in Uganda.

The prevalence of bovine anaplasmosis was studied in 320 Zebu cattle randomly selected from three regions of Uganda: (Central, Southwestern and Northwestern) using dot-ELISA, Western immunoblotting, rapid card agglutination test (RCAT), capillary tube agglutination test (CAT), complement fixation test (CFT), and parasitological techniques. Dried blood on Whatman filter paper No. 1 was eluted in PBS 0.05% Tween 20 prior to testing at an initial dilution of 1:25. The prevalences of parasitaemia were 25% in the central region, 28% in the southwestern region, and 35% in the northwestern region, and the serological prevalence was lowest in the central region and highest in the northwest. Overall, prevalence rates obtained by dot-ELISA (61.9%) and Western immunoblotting (62.5%) were 1.5 times those obtained by RCAT (41%) and three times those obtained by CAT (22.5%). The overall prevalence rates obtained by dot-ELISA and Western immunoblotting compared favourably with the CFT data. The present data utilizing dried blood on filter papers indicate that there is a high prevalence of anaplasmosis in those regions of Uganda surveyed, and confirm our observations and those of others that collecting blood on filter papers is a suitable technique for large scale screening and for seroepidemiological studies.

Agglutination Tests↗

Women for women's health: Uganda.

The primary health care model targets social, political, and economic environments as key determinants of health for populations, as well as for individuals. If nursing in Uganda is to make a difference in health care outcomes and in the health of all Ugandans, nurses must look broadly at situations and be educated to practice primary health care nursing. After 14 years of civil war, Uganda is finally experiencing a period of reconstruction and rehabilitation: the whole infrastructure is undergoing a face-lift. Ugandan nurses recognize that their educational preparation has stagnated for many years and that it was not only the political unrest in their country that put them behind professionally. They realize that, given the new directions set by the government, they must become prepared to implement primary health care. They are demanding a university education so they may take their place alongside other health care providers prepared at the university level. Some of the most convincing arguments for a university program for nurses came from doctors at the university who spoke about the need to raise the standards of nursing practice, the quality of teachers, and the morale of practitioners. One nurse said: "If we lose hope for a BScN program, I think all the nurses will quit and we won't have any new students going into the profession." This program is designed to improve the health and well-being of all Ugandans, especially the most vulnerable groups of women and children in rural areas, through strengthening and expanding health services by targeting the educational preparation of nurses. Health planners in Uganda envision the professional nurse as key to the implementation of the national health policy of primary health care. University-educated nurses should be able to assess problems, make clinically sound decisions, and act appropriately within the scope of nursing practice. They should be able to interact and consult collegially with other health care professionals. Placed in rural community sites, nurses should function independently as community leaders, health education facilitators, primary health care practitioners, and educators for nursing students. Such intervention in community health care by BScN nurses should improve health care utilization and decrease mortality and morbidity from preventable causes. BScN nurses should make an impact on health care policy, nursing education, and primary health care. The evaluation of this project needs to be as comprehensive as its development and implementation. It will focus on health outcomes, particularly for women and children in rural areas of Uganda. Measurement of the effects of the process of nursing education (the BScN curriculum) in terms of output (nurses educated and placed in rural practice, nursing education, or government policy posts), outcomes (change in health status of rural communities), and broader impacts (changes in the status of women and in government policy toward women, nurses, or health at the local, regional, and national levels) is planned. An element of sustainability is present, as an operations research structure will be left in place at the community level. Timing, as the saying goes, is everything, and this project has had good timing. Our belief in the efforts and the goals of the project also gave us the strength to get support from various funding agencies for "small" things. For example, we got support from churches in the United States for building schools in Uganda; we persisted with the women's income-generating project when other support was pulled; we got books for the library in Uganda and got clothes, books, and furnishings for the students who came to this country. The motivation for project personnel has been altruism. The services that the two consultants provided to their Ugandan colleagues have extended far beyond the scope of the project.

Education, Nursing, Baccalaureate↗

Influences of mother's work, childhood place of residence, and exposure to media on breast-feeding patterns: experience of Nigeria and Uganda.

This study uses data from the Nigerian Demographic and Health Survey collected in 1990 and the Ugandan Demographic and Health Survey collected in 1995 to examine the implications of mother's work, childhood place of residence, and exposure to the media for breast-feeding patterns (exclusivity and intensity) in Nigeria and Uganda. Nigeria and Uganda present an interesting contrast because Nigeria is more modernized and economically developed than Uganda, thus providing a good indication of the influence of modernization on breast-feeding patterns. Mother's work status is defined by considering whether mothers earned cash from work and took their children to work, hence emphasizing the compatibility of work with child care. Work least compatible with child care had a negative effect on breast-feeding intensity in Nigeria. The negative effect of mother's work on exclusive breast-feeding (that is, if the mothers used formula or milk instead) observed for some working mothers in Nigeria and Uganda was partly confounded by urban residence, exposure to media, and other socioeconomic factors. Mother's work did not have a negative effect on breast-feeding intensity in Uganda. The relationship between mother's work, urban residence, media exposure, and breast-feeding practice seems to be stronger in Nigeria than Uganda.

Adolescent↗

Occurrence of Shiga toxin-producing Escherichia coli in fecal samples from children with diarrhea and from healthy zebu cattle in Uganda.

Fecal samples collected from 237 diarrheic infants in Kampala, Uganda and from 159 healthy cattle from a ranch in the Central Region of Uganda were investigated for the presence of Escherichia coli O157 and other types of Shiga toxin-producing E. coli (STEC). E. coli O157 were not detected in 150 stool samples from children which were cultivated on sorbitol MacConkey agar. A search for all types of STEC performed on 87 additional human stool samples with an enzyme-immunoassay for Shiga toxins (Premier EHEC) was also negative. Forty-two stool samples from infants were additionally investigated for enteropathogenic E. coli (EPEC) by DNA-hybridization with an eae-specific gene probe. Compared to STEC, EPEC were frequent and found in six (14.3%) of these 42 randomly selected stool specimens. We were further interested in the role of cattle as a reservoir for STEC in Uganda. STEC were isolated from 45 of 159 cattle from a herd in the Central Region of Uganda. STEC strains from cattle belonged to 16 different O- and nine different H-types and nine O:H types were identical to those found in bovine STEC from other continents. Only one bovine STEC strain was positive for the eae-gene, and O-groups associated with enterohemorrhagic E. coli (EHEC) types (O26, O103, O111, O145 and O157) were not found. Our report demonstrates that STEC are not frequent in urban children in Uganda, but domestic cattle were identified as an important natural reservoir for these organisms in this country.

Animals↗

Prevalence of aggressive periodontitis in school attendees in Uganda.

AIM: The prevalence and severity of early onset periodontitis (EOP) among students attending secondary schools in two regions of Uganda was studied. MATERIAL AND METHODS: 690 students (393 males and 297 females) aged 12-25 years (mean 17 years), representing a range of tribal groups, were recruited from six schools in the peri-urban Central and rural Western regions of Uganda. The study subjects were clinically examined in field conditions by a single calibrated examiner to measure gingival recession and probing depth at six sites per tooth, with subsequent calculation of clinical periodontal attachment level for each site. Subjects exhibiting >or= 4 mm of clinical periodontal attachment loss at approximal surfaces of one or more teeth were classified with EOP. A structured written questionnaire obtained demographic characteristics of the study subjects. RESULTS: 199 (28.8%) study subjects showed clinical features of EOP, of which 16 (2.3%) subjects exhibited generalized EOP, 29 (4.2%) localized EOP, and 154 (22.3%) incidental EOP. The percentage of EOP-affected males was significantly higher than females (33.8% vs. 22.2%, P < 0.001). EOP prevalence tended to increase with increasing age, but no association was found between EOP prevalence and socioeconomic status or residency in urban vs. rural areas of Uganda. Molars and mandibular incisors generally demonstrated the highest occurrence of >or= 4 mm attachment loss. Clinical periodontal attachment loss of >or= 5 mm was mainly seen at first molars and incisors, suggesting that these two tooth types are first affected with attachment loss. Approximal tooth surfaces showed greater probing depth and attachment loss than buccal and lingual surfaces. Gingival recession was most prevalent at mandibular anterior teeth, whereas gingival margin coronal to CEJ was most frequently observed at second molars and maxillary incisors. CONCLUSION: A relatively high prevalence of EOP (28.8%) was found in young Ugandan school attendees, with 6.5% of these showing severe disease. EOP in Uganda was significantly more prevalent in males than females, and most frequently characterized by approximal involvement of molars and mandibular incisors. Etiologic and predisposing factors associated with the high occurrence of EOP in Uganda, as well as therapeutic and preventive measures of the disease in this population, remain to be delineated.

Adolescent↗

Melarsoprol refractory T. b. gambiense from Omugo, north-western Uganda.

Culture adapted T. b. gambiense isolated from Northwest Uganda were exposed to 0.001-0.14 microg/ml melarsoprol or 1.56-100 microg/ml DL-alpha-difluoromethylornithine (DFMO). Minimum inhibitory concentrations (MICs) of each drug were scored for each isolate after a period of 10 days drug exposure. The results indicate that T. b. gambiense isolates from Northwest Uganda had elevated MIC values for melarsoprol ranging from 0.009 to 0.072 microg/ml as compared with T. b. gambiense isolates from Cote d'Ivoire with MIC values ranging from 0.001 to 0.018 microg/ml or with T. b. rhodesiense from Southeast Uganda with MIC values from 0.001 to 0.009 microg/ml. All MIC values obtained fell below expected peak melarsoprol concentrations in serum of treated patients. However, it may not be possible to maintain constant drug concentrations in serum of patients as was the case in our in vitro experiments. Importantly, the MIC of 0.072 microg/ml exhibited by one of the isolates from Northwest Uganda was above levels attainable in CSF indicating that this isolate would probably not be eliminated from CSF of treated patients. PCR amplification of the gene encoding the P2-like adenosine transporter followed by restriction digestion with Sfa NI enzyme revealed presence of fragments previously observed in a trypanosome clone with laboratory-induced arsenic resistance. From our findings it appears that reduced drug susceptibility may be one factor for the frequent relapses of sleeping sickness after melarsoprol treatment occurring in Northwest Uganda.

Animals↗

Isolation and characteristics of Mycobacterium avium complex from water and soil samples in Uganda.

SETTING: Mycobacterium avium complex organisms have not been isolated from late stage AIDS patients in Uganda. This could possibly be due to the absence of M. avium complex in the Uganda environment. OBJECTIVE AND DESIGN: Determine whether M. avium complex organisms could be isolated from water and soils collected in the living environment of Ugandan AIDS patients. RESULTS: Representatives of the M avium complex were isolated from 3 of 7 (43%) water and 3 of 7 (43%) soil samples collected in Kampala, Uganda. The average number of colony-forming units per ml water was 3.3 and average colony-forming units per gram of soil was 7825. In terms of growth characteristics, antimicrobial susceptibility patterns, and the presence or absence of plasmids and IS901, Ugandan M. avium complex isolates were similar to those isolated from the US and European AIDS patients and their environment. CONCLUSIONS: M. avium complex organisms sharing genetic and physiological characteristics of M. avium complex isolates recovered from patients with AIDS can be isolated from water and soil samples in Uganda.

Colony Count, Microbial↗

The seroprevalence of antibodies to toxoplasma gondii in domestic goats in Uganda.

Only limited epidemiological information is available on the seroprevalence of Toxoplasma gondii in domestic livestock in sub-Saharan Africa. In Uganda, goats are important to the local economy and are also popular food animals. A high incidence of T. gondii infection in goats would have implications both for animal production and for public health, but no data is available on Toxoplasma infection in these animals. In this study we estimated the seroprevalence of antibodies against T. gondii in goats located in both urban and rural environments and from different geographical regions within Uganda. Goat sera were collected using a random, two-stage clustering method. Of 784 samples analysed by antibody-ELISA from various districts in Uganda, 240 tested positive. The combined (cluster-adjusted) seroprevalence was 0.31 (31%) (95% confidence intervals 0.28, 0.34) indicating a substantial level of infection in these regions. Seroprevalence was significantly higher in goats from urban locations. A strong positive relationship between age and seroprevalence was demonstrated and a mathematical model based on continuous exposure proved generally accurate in predicting seroprevalence. Farm environments were identified as being suitable for oocyst survival and transmission, and the reported incidence of caprine abortion was high. The importance of toxoplasmosis to goat production in Uganda has yet to be determined, but the high seroprevalence detected in this study suggests that it may have a significant impact and that the consumption of goat meat may play a role in zoonotic transmission to humans.

Animals↗

Epidemiological assessment of rinderpest surveillance and control in Uganda between 1990 and 1998.

Based on passive and active data, we report on an epidemiological assessment of surveillance and control of rinderpest (RP) in Uganda between 1990 and 1998. Active data were collected by administration of questionnaires to animal health personnel and their auxiliaries and to stockowners in six selected districts of eastern and northeastern Uganda. Passive data were extracted from vaccination and seromonitoring reports, and from field and laboratory reports. RP events were classified as "confirmed outbreaks", "suspected outbreaks" and "rumours". The classification of 56% of the RP events as "suspected outbreaks" indicates the difficulty in investigating disease outbreaks in Uganda. Although vaccination coverage and seroprevalence were <85% (the recommended target), they nevertheless corresponded well-reflecting effective vaccination. However, because of the low seroprevalence, a sizable population of cattle in Uganda remained at risk of RP. The agreement between the local and national disease reporting systems was low-to-moderate (kappa=0.39); this indicates inefficiency in disease reporting. Risk factors for RP outbreaks were cattle raids and communal grazing. Based on overlaid thematic maps of seroprevalence, vaccination coverage and RP events, close spatial and temporal associations were observed between cattle raids, transhumance and outbreaks and rumours. The high-risk areas were in the eastern and northeastern parts of the country. The results of this study support a phase approach of following the OIE pathway.

Animals↗

Financial analysis of dipping strategies for indigenous cattle under ranch conditions in Uganda.

A financial analysis was performed to assess the performance of three acaricide-treatment groups of indigenous breeds (Zebu and Nganda) of cattle on a ranch in Luwero District, Uganda. The treatments were based on different frequencies: twice-a-week dipping, once-a-month dipping and no tick control. The objective was to evaluate the economic justification for intensive acaricide application for tick and tick-borne disease control in Uganda. Data were collected by monitoring cattle performance over a period of 34 months. Biological data collected included the number of cows at the beginning and end of the study, net starting liveweight, number of calves born, number of animals dying due to tick-borne diseases and other causes, number of animals sold or slaughtered and milk yield. Records of variable costs (acaricides, drugs, labour, etc.) and output prices were assembled and calculated by treatment group. Gross margin and marginal analysis were used in the financial analysis. The exchange rate in 1990-1993 was one US$ to 1200 Uganda shillings. The gross benefits obtained from animal sales, herd value and milk yield were Uganda shillings 1175, 1389 and 1311 per kg of net starting liveweight for animals dipped twice-a-week, once-a-month and not dipped, respectively. The variable costs were Ug. shs. 424, 390 and 360 per kg of net starting liveweight, respectively. Consequently, the gross margins were Ug. shs. 751, 999 and 951 per kg of net starting liveweight. Furthermore, the marginal rate of return (MRR) in changing from no tick control to once-a-month dipping was 160%, while changing from no tick control to twice-a-week dipping was negative (-313%). The above results showed that the value of increased gains in production obtained from twice-a-week dipping strategy does not offset the costs of inputs for intensive dipping. Once-a-month dipping (strategic) therefore appears to be the most-profitable tick-control strategy for the farmer. The need to conduct further studies in different livestock- production systems and to rationalise future tick control policies is discussed.

Administration, Topical↗

Survey of radiography and radiation protection in general dental practice in Uganda.

OBJECTIVES: To carry out the first survey in Uganda of all dentists and all public health dental officers (PHDO) to assess the status of dental radiography and radiation protection. METHODS: All 74 dentists and 76 PHDOs in Uganda were sent a postal questionnaire including 33 questions relating to various demographic details, radiographic equipment and radiographic techniques, including processing and radiation protection. A second questionnaire was sent to non-respondents after 3 months. RESULTS: Eighty-two per cent of dentists responded and 83% of PHDOs. Seventy per cent of the dentists and 100% of the PHDOs were trained in Uganda. Seventy-five per cent of the dentists and 30% of the PHDOs had access to one of the approximately 30 X-ray machines in the country. The majority of the equipment did not comply with current recommendations in Europe. Fifty-one per cent of dentists used machines with mechanical timers, 28% used machines with no visual warning signal and 17% used equipment with no audible warning signal. Most of the equipment was over 30 years old and only 15% of dentists knew when the equipment was last serviced. The most relevant finding of the surveys was the level of 'don't know' responses to many questions from both groups. CONCLUSIONS: The lack of knowledge regarding dental radiography and radiation protection plus the condition of most equipment in Uganda is a matter of concern. Standards of care are considerably lower than in developed countries requiring improved undergraduate training, provision of postgraduate courses and Ugandan governmental or international financial assistance.

Adult↗