Rural Communities In Uganda Research Articles

Human Herpesvirus 8 Infection in Children and Adults in a Population-based Study in Rural Uganda

Human herpesvirus 8 (HHV-8) infection is endemic in sub-Saharan Africa. We examined sociodemographic, behavioral, and biological factors associated with HHV-8 infection in children and adults to determine HHV-8 seroprevalence and potential routes of transmission. Participants were 1383 children and 1477 adults from a population-based sample in a rural community in Uganda. Serum samples were tested for HHV-8 antibodies with use of an enzyme immunoassay against K8.1. HHV-8 seroprevalence increased from 16% among children aged 1.5-2 years to 32% among children aged 10-13 years (P <.001) and from 37% among participants aged 14-19 years to 49% among adults aged ≥ 50 years (P <.05). HHV-8 seropositivity in children was independently associated with residing with a seropositive parent (P < .001) and residing with ≥ 1 other seropositive child aged <14 years (P < .001). History of sharing food and/or sauce plates was marginally associated with HHV-8 infection in children (P = .05). Among 1404 participants aged ≥ 15 years , there was no association between correlates of sexual behavior (eg, number of lifetime sex partners and HIV infection) and HHV-8 seropositivity (P > .10). Our data suggest that HHV-8 is acquired primarily through horizontal transmission in childhood from intrafamilial contacts and that transmission continues into adulthood potentially through nonsexual routes.

Harvesting and Processing of Balanites aegyptiaca Leaves and Fruits for Local Consumption by Rural Communities in Uganda

Harvesting and Processing of Balanites aegyptiaca Leaves and Fruits for Local Consumption by Rural Communities in Uganda

Perceptions of the role of ICT on quality of life in rural communities in Uganda

The role of information and communication technology (ICT) in enabling various development goals including the millennium development goals and ultimately human development is no longer disputed. Emphasis is now being placed on optimizing ICT benefits on the quality of life (QoL) of people, especially in developing countries. To address this need, this paper reports a study that applied Sen's capability approach to explore how individuals in rural communities in Uganda perceived the importance of ICT toward their QoL and how this perception influenced ICT adoption. It was established that while perception was inclined to social benefits, ICT uptake and use toward improved QoL is still limited. One reasonable conclusion is therefore that state and policymakers should adopt a pluralistic approach to ICT provision: one that does not only focus on availability and affordability, but also considers expanding people's awareness and agency for development benefit. ICT investments otherwise have a high risk of being severely underutilized.

Heritability of Plasmodium Parasite Density in a Rural Ugandan Community

Many factors influence variation in Plasmodium infection levels, including parasite/host genetics, immunity, and exposure. Here, we examine the roles of host genetics and exposure in determining parasite density, and test whether effects differ with age. Data for 1,711 residents of an eastern Ugandan community were used in pedigree-based variance component analysis. Heritability of parasite density was 13% (P < 0.001) but was not significant after controlling for shared household. Allowing variance components to vary between children (< 16 years) and adults (≥ 16 years) revealed striking age differences; 26% of variation could be explained by additively acting genes in children (P < 0.001), but there was no genetic involvement in adults. Domestic environment did not explain variation in children and explained 5% in adults (P = 0.09). Genetic effects are an important determinant of parasite density in children in this population, consistent with previous quantitative genetic studies of Plasmodium parasitaemia, although differences in environmental exposure play a lesser role.

Hurdles and opportunities for newborn care in rural Uganda

Introduction a set of evidence-based delivery and neonatal practices have the potential to reduce neonatal mortality substantially. However, resistance to the acceptance and adoption of these practices may still be a problem and challenge in the rural community in Uganda. Objectives to explore the acceptability and feasibility of the newborn care practices at household and family level in the rural communities in different regions of Uganda with regards to birth asphyxia, thermo-protection and cord care. Methods a qualitative design using in-depth interviews and focus group discussions were used. Participants were purposively selected from rural communities in three districts. Six in-depth interviews targeting traditional birth attendants and nine focus group discussions composed of 10–15 participants among post childbirth mothers, elderly caregivers and partners or fathers of recently delivered mothers were conducted. All the mothers involved has had normal vaginal deliveries in the rural community with unskilled birth attendants. Latent content analysis was used. Findings two main themes emerged from the interviews: ‘Barriers to change’ and ‘Windows of opportunities’. Some of the recommended newborn practices were deemed to conflict with traditional and cultural practices. Promotion of delayed bathing as a thermo-protection measure, dry cord care were unlikely to be accepted and spiritual beliefs were attached to use of local herbs for bathing or smearing of the baby’s skin. However, several aspects of thermo-protection of the newborn, breast feeding, taking newborns for immunisation were in agreement with biomedical recommendations, and positive aspects of newborn care were noticed with the traditional birth attendants. Conclusions some of the evidence based practices may be accepted after modification. Behaviour change communication messages need to address the community norms in the country. The involvement of other newborn caregivers than the mother at the household and the community early during pregnancy may influence change of behaviour related to the adoption of the recommended newborn care practices .

Spatial and genetic epidemiology of hookworm in a rural community in Uganda.

There are remarkably few contemporary, population-based studies of intestinal nematode infection for sub-Saharan Africa. This paper presents a comprehensive epidemiological analysis of hookworm infection intensity in a rural Ugandan community. Demographic, kinship, socioeconomic and environmental data were collected for 1,803 individuals aged six months to 85 years in 341 households in a cross-sectional community survey. Hookworm infection was assessed by faecal egg count. Spatial variation in the intensity of infection was assessed using a Bayesian negative binomial spatial regression model and the proportion of variation explained by host additive genetics (heritability) and common domestic environment was estimated using genetic variance component analysis. Overall, the prevalence of hookworm was 39.3%, with the majority of infections (87.7%) of light intensity (≤1000 eggs per gram faeces). Intensity was higher among older individuals and was associated with treatment history with anthelmintics, walking barefoot outside the home, living in a household with a mud floor and education level of the household head. Infection intensity also exhibited significant household and spatial clustering: the range of spatial correlation was estimated to be 82 m and was reduced by a half over a distance of 19 m. Heritability of hookworm egg count was 11.2%, whilst the percentage of variance explained by unidentified domestic effects was 17.8%. In conclusion, we suggest that host genetic relatedness is not a major determinant of infection intensity in this community, with exposure-related factors playing a greater role.

Perceptions on onchocerciasis and ivermectin treatment in rural communities in Uganda: implications for long-term compliance

Registers of community-directed distributors of ivermectin for onchocerciasis from 2000 to 2005 were reviewed to identify people highly and poorly compliant to ivermectin treatment. Compliance was termed 'high' if a person took annual ivermectin ≥4 out of 6 times and 'poor' if it was taken <4 times. Individuals (409 and 362 highly and poorly compliant, respectively) were interviewed on knowledge of onchocerciasis, severity of the disease, benefits of ivermectin treatment and its adverse events. Those who believed onchocerciasis to be a serious disease and also believed ivermectin treatment alleviated symptoms (71.9%), were highly compliant compared with (37.7%) who believed that onchocerciasis was not a serious disease and ivermectin did not alleviate symptoms (P < 0.001). Those who believed that ivermectin caused itchiness were 6.1% and 39.5% of highly and poorly compliant respectively (P < 0.001). Given that people more highly compliant with ivermectin mass drug administration (MDA) appear to better recognize the severity of onchocerciasis and the salutary effects of ivermectin, their enthusiasm to take ivermectin should be maintained through regular health education on the benefits and importance of continued treatment, and proper management of adverse events. The conclusions drawn in this article may equally apply to other MDA programmes.

Malaria Prevention in Sub-Saharan Africa: A Field Study in Rural Uganda

Malaria, a completely preventable and treatable disease, remains one of the biggest killers in Sub-Saharan Africa today. The objectives of this study were to describe the impact of malaria on a small rural community in Uganda (Bufuula) and to implement and evaluate a malaria prevention program (subsidised insecticide treated nets with an accompanying education session). In January 2006, a survey of 202 households (100% response rate) was conducted, and meetings held with the Village Council, which revealed that malaria was the community's major cause of morbidity and mortality, and showed there was a lack of access to preventative measures. Furthermore, 34% of each household's income was allocated to the burden of malaria. A malaria education and mosquito net distribution session was held in January 2006, which was attended by over 500 villagers who purchased 480 heavily-subsidised long lasting insecticide treated nets (LLINs). Home visits were conducted 1 week later to ensure the LLINs were hung correctly. A follow-up survey was conducted in January 2007. There was a rise in net ownership following the program (18% to 51%, P < 0.0001) and lower rates of childhood malaria prevalence (14%) than reported in Ugandan national statistics (40%). However, only half the nets owned were being used correctly by those most vulnerable to the illness. The findings suggest that mosquito nets must be provided with an effective education program and may be more successful if conducted in whole districts simultaneously rather than on a per-community basis. The evidence for super-targeting strategies for those most vulnerable is also considered. These findings provide important lessons and considerations for other wide-scale malaria prevention programs.

Communities and health research: an opinion piece on ‘Community engagement in health research: two decades of experience from a research project on HIV in rural Uganda’, in the February 2009 issue of Tropical Medicine and International Health

This commentary discusses a paper by Nakibinge that illustrates the value of multi-faceted integrated approach to community engagement in health research. It also argues that the strong evidence base for effectiveness and the value of community engagement is still lacking but the study by Nakibinge provides indications which should be considered priorities in the future work in the important area of health research.

Letters, Imagined Communities, and Literate Identities: Perspectives from Rural Ugandan Women

Historically, letter reading and writing have been pervasive across human societies, cultures, and communities (Barton &amp; Hall, 2000). Like all literate activities, it derives its meaning and significance from how it is situated within cultural beliefs, values, and practices. Despite its prevalence, however, little is known about the meanings and uses of letter reading and writing in diverse cultural contexts. The purpose of this article is to examine the desire to independently read and write letters as a rationale for rural Ugandan women to join an adult literacy program. Drawing on sociocultural theories, and in particular, the frameworks of a literacy ecology of communities, communities of practice, and imagined communities, the authors use ethnographic techniques to explore the role of letter reading and writing in the lives of 15 women participating in an adult literacy program in 1 rural Ugandan community. The authors argue that letter reading and writing practices, personhood, and identity are intertwined within an imagined community to which these women hope to belong, and these imagined communities may play a critical role in their success in adult literacy programs.

Christianity and rural community literacy practices in Uganda

In this article, we examine how Christianity provides the impetus for local literacy practices in a rural community in Uganda. These Christian literacy practices form a central part of the literacy activities of the community and are manifested in a variety of contexts from public to private, using a wide variety of readily available religious texts in the community. Through examination of Christian literacy practices, the authors suggest that ethnographic research has the potential to generate information that can be used to enhance literacy learning in rural community life.

LOGISTIC PREPARATION TO ENABLE THE BRIGHTER SMILES AFRICA PROGRAM TO BE ESABLISHED IN UGANDA.

Background The implementation of a successful international health program comes with a constellation of unique obstacles that require a collaborative approach and careful project design. Over the summer of 2006, a Canadian school-based tooth-brushing and oral health education program, “Brighter Smiles,” was delivered to 600 primary school children in four rural Ugandan communities in Africa. The international program resulted from collaboration between the University of British Columbia (UBC), Vancouver, BC, and Makerere University (MU), Kampala, Uganda, and was implemented in 2006 by medical and dental students from both institutions. Methods Initiation of the Brighter Smiles Program in Uganda was requested by MU faculty members and the third-year dental class. Once collaboration was confirmed, planning began. Initial sessions with the UBC medical students were done in the aboriginal communities to enforce the basic program philosophy and teaching. Fundraising and grant competitions were conducted. An initial contact team composed of two medical students was sent to present the basic program at a local conference and then with faculty on board to begin the adaptation of the program to suit Uganda9s children9s community and write culturally appropriate ethics and protocols. The project then moved into all four communities under the leadership of the Ugandan dental students, who obtained preliminary consents for the project and baseline dental surveys of the children. The main UBC team then arrived for the implementation of the bulk of the project (teaching dental health, brushing techniques, and supply distribution) and while supporting the Ugandan students in this phase of the project saw their collaboration come to life. Results The 2006 pilot year of the program was embraced by target communities and is successfully under way. Six hundred children received baseline dental examinations and enrolled in the oral health tooth-brushing program. In the coming year, the program will be reinforced in Uganda by another cohort of UBC students. Key relationships were established to act as a substrate for future public health initiatives between UBC and MU. Conclusion The implementation of the “Brighter Smiles Program” in Uganda demonstrates the importance of solid preparation in advance and how the potential success of a true collaboration between international universities and local communities depends on this logistic preparation.

MEETING THE CHALLENGE OF TRANSLATING A SUCCESSFUL CANADIAN COMMUNITY HEALTH INITIATIVE TO SUB-SAHARAN AFRICA.

Background In 2006, the initial collaboration between the University of British Columbia, Canada, and Makerere University, Uganda, Africa, began with a pediatric dental health project initiated by students enrolled in the third year of dentistry at Makerere University and first- and second-year medical students at the University of British Columbia and the Pediatrics Department. The purpose of this study is to identify the challenges experienced in adapting a successful pediatric community health program onto an international platform. Methods Through observation and discussion throughout the planning and initiation of the collaborative international project many challenges were identified. Results The concept of the project both in the actual intervention and the desire to improve children9s oral health and influence the overall health of the community were ubiquitous in both initiatives. However, the implementation of this wish was very different. Challenges arose in identifying and procuring appropriate grants and project sponsors as well as finding team members to undertake the project. Logistical obstacles became apparent in accessing needed supplies in a developing country. Delivery of the health initiative at a community level was very challenging for the project; students faced a language barrier, a very different school system, and hundreds more children participating at one time than in any of the prior Canadian initiatives. More than 600 children from 4 rural Ugandan communities were enrolled in the project over a 1-month time period. Conclusions Despite the challenges faced in initiating the international Ugandan-Canadian Paediatric Dental Health Collaboration, teams from both collaborating universities recognized that the ‘growing pains’ were well worth the extra effort. The capacity was built for community education and research for the Ugandans and the Canadians gained invaluable insight into health care and research priorities in a developing country. The children of Uganda able to participate in this international community health program will become the clear winners.

Use of postpartum health services in rural uganda: knowledge, attitudes and barriers

The purpose of this study was to explore the knowledge, attitudes and barriers to use of postpartum care service among rural communities in Uganda. Study was a part of a larger reproductive health evaluation project, and was cross-sectional in nature utilizing qualitative research methods using the narrative inquiry. Two matched rural communities were used in this study; Semuto in Luwero district, and Lwamaggwa in Rakai district. Fifty key informants who were purposefully selected from each study site were interviewed. They included community leaders, political leaders, health care providers, women leaders and community members. One-on-one interviews were conducted with key community informants using an interview guide. The purpose of the interview was explained to each participant, and written informed consent was obtained before the start of the interview. Respondents were allowed to express their views, opinions and observations on several health issues including postpartum health care services. There was a low level of knowledge about postpartum care services among the respondents of the two communities. There was lack of awareness about postpartum care and it's benefits. The main barriers to use of services were; misconceptions regarding the importance of postpartum care, distance to health facilities, poverty, and health system factors notably; poor facilities, lack of essential drugs, and poor attitudes of health workers. In the effort to improve reproductive health care services, there is an urgent need to improve postpartum services, and make them more accessible and user friendly. The training of providers at all levels is essential, in addition to educating families on the importance of postpartum care services.

Towards a Better Understanding of Exclusive Breastfeeding in the Era of HIV/AIDS: A Study of Prevalence and Factors Associated with Exclusive Breastfeeding from Birth, in Rakai,Uganda

Exclusive breastfeeding (EBF) is being promoted by WHO/UNICEF as the recommended mode of feeding for all infants from birth to around 6 months of age. It is also recommended for the initial few months, for infants born to HIV-positive mothers in the developing world where conditions may not be ideal for replacement feeding. A cross-sectional study was done to find the prevalence and factors associated with EBF from delivery, amongst mothers of infants 0-6 months of age in a rural Ugandan community with a high HIV/AIDS burden. A prevalence of EBF of 35.1 per cent was found. There was a very high use of prelacteal feeds. Factors positively associated with EBF from birth, after logistic regression, were: delivery from a health unit (OR 2.07; 95 per cent confidence interval, 1.2-3.6); and mother having a normal vaginal delivery (OR 10.54; 95 per cent CI, 3.0-36.6). Factors showing negative association were: male gender of child (OR 0.44; 95 per cent CI, 0.3-0.7); and age of child over 3 months (OR 0.48; 95 per cent CI, 0.3-0.7). Mothers knowledge of her HIV serostatus was not associated with EBF (p = 0.78). Breastfeeding is almost universal in this area but it is rarely exclusive from birth.

Syndromic management of sexually-transmitted infections and behaviour change interventions on transmission of HIV-1 in rural Uganda: a community randomised trial

Treatment of sexually-transmitted infections (STIs) and behavioural interventions are the main methods to prevent HIV in developing countries. We aimed to assess the effect of these interventions on incidence of HIV-1 and other sexually-transmitted infections. We randomly allocated all adults living in 18 communities in rural Uganda to receive behavioural interventions alone (group A), behavioural and STI interventions (group B), or routine government health services and community development activities (group C). The primary outcome was HIV-1 incidence. Secondary outcomes were incidence of herpes simplex virus type 2 (HSV2) and active syphilis and prevalence of gonorrhoea, chlamydia, reported genital ulcers, reported genital discharge, and markers of behavioural change. Analysis was per protocol. Compared with group C, the incidence rate ratio of HIV-1 was 0.94 (0.60-1.45, p=0.72) in group A and 1.00 (0.63-1.58, p=0.98) in group B, and the prevalence ratio of use of condoms with last casual partner was 1.12 (95% CI 0.99-1.25) in group A and 1.27 (1.02-1.56) in group B. Incidence of HSV2 was lower in group A than in group C (incidence rate ratio 0.65, 0.53-0.80) and incidence of active syphilis for high rapid plasma reagent test titre and prevalence of gonorrhoea were both lower in group B than in group C (active syphilis incidence rate ratio, 0.52, 0.27-0.98; gonorrhoea prevalence ratio, 0.25, 0.10-0.64). The interventions we used were insufficient to reduce HIV-1 incidence in rural Uganda, where secular changes are occurring. More effective STI and behavioural interventions need to be developed for HIV control in mature epidemics.

Obesity and gender differences in the risk of type 2 diabetes mellitus in Uganda

OBJECTIVE: We assessed the severity of type 2 diabetes in urban and rural communities of Uganda and characterized this disease according to sex, obesity, and hypertension. METHODS: A total of 440 subjects was tested for high blood and urine glucose levels with the respective glucometers and sample strips. Body mass index and hypertension were determined by measuring height, weight, and blood pressure. RESULTS: In a random study conducted in the communities of the districts of Kampala and Mokono, the prevalence of type 2 diabetes was found to be about 8.1% ( n = 148). An association between obesity, hypertension, and risk of type 2 diabetes was found among the women, of whom nearly 80% were overweight. However, the men, who were primarily lean, did not exhibit this same correlation. CONCLUSIONS: These epidemiologic data suggest a variance from the strong correlation of type 2 diabetes and obesity seen in Western countries and most of Europe. Specifically, the etiology of this disease in Uganda is different between men and women. The reasons for this phenomenon are not well elucidated, but it is likely that a long history of obesity in women may genetically or environmentally predispose them to this disease.

Determinants of child mortality in a rural Ugandan community.

To estimate the rate of and risk factors associated with child mortality in rural eastern Uganda. A community based cross-sectional study using the preceding birth technique--a robust method of obtaining information of survival of the previous child. A rural district in Eastern Uganda. In total, 2888 multigravidae were interviewed in April and May 1999. Number of deaths among children born alive. The under-two child mortality rate was 108 per 1000 livebirths. The annual child mortality was 82 per 1000 child-years of risk. Child mortality was associated with low parental education, being born to adolescent mothers or mothers aged 35 or more. Unconditional logistic regression showed that children born to uneducated parents had a doubled risk of not celebrating their second birthday. It was three times more likely for a child to die in the neonatal period than in the first year of life. Child mortality risk decreased by 4% and 6% for every year of education attained by mothers and fathers, respectively. Parity, residence and marital status were not associated with excess risk of child mortality. Seasonal mortality followed the El Nino rainfall pattern. Finally, there were geographical differences in child mortality although this was not statistically significant. Monitoring trends in child mortality at district level can be done using the preceding birth technique in antenatal settings. Maternal education, an important predictor of child survival should be included in routine data collection at clinics.

In rural Ugandan communities the traditional kinship/clan system is vital to the success and sustainment of the African Programme for Onchocerciasis Control.

In rural Ugandan communities where onchocerciasis is meso- or hyper-endemic, control of the disease is now being carried out using a strategy of community-directed programmes for the annual distribution of ivermectin to all persons eligible to take the drug. For these programmes to achieve their annual target coverage of at least 90% of the population eligible to take ivermectin, and to continue to sustain themselves for 10-15 years or more, even after external donor funding ceases, it has been found essential to replace the initial community-based strategy, imposed from outside, by a community-directed strategy developed by the community members themselves. Furthermore, it is essential for success that full use be made of the traditional social system, which is very strong in all rural communities in Uganda. This system is based on patrilineal kinships and clans, governed by traditional law, and in it women pay an important role. If this system is ignored or by-passed by government health personnel or by the sponsors and promoters of the programme, the communities are likely to fail to reach their targets. When rural communities increase in size and complexity, following development and the arrival of migrant families, they become semi-urbanized. The kinship/clan system is then weakened, community-directed drug distribution is much more difficult to organize, and coverage targets are not often achieved. This effect is of minor importance in a rural disease, such as onchocerciasis, but is likely to be of greater significance in the control of diseases, such as tuberculosis and lymphatic filariasis, which thrive in urban environments.

The burden of mucocutaneous conditions and the association with HIV-1 infection in a rural community in Uganda.

To determine the prevalence of mucocutaneous conditions and their association with HIV-1 infection in a rural community in Uganda. In a prospective cohort study, participants were recruited from a large population study and invited to attend a clinic every 3 months for a detailed medical interview and a thorough physical examination. All findings including mucocutaneous findings were coded onto a standard questionnaire. By the end of 1996, 436 participants had provided 1450 person years of observation (pyo); 646 pyo in HIV-positives and 804 pyo in HIV-negatives. Overall, 70% of participants had a skin condition during follow-up, and although skin conditions were significantly more common in HIV-positive subjects, the background level in HIV-negative subjects was high (77.3% and 63.6%, respectively). Herpes zoster, thin/sparse hair, maculo-papular rash and prurigo were significantly more common in the HIV-positives. Kaposi sarcoma, palmar/plantar rash and herpes zoster had positive predictive values for HIV infection of over 80%. Oral conditions were found in over 40% of participants and were significantly more common in HIV-positive subjects. Oral candidiasis and Kaposi sarcoma were significantly more frequent among HIV-positives. HIV infection increases the already high burden of mucocutaneous diseases in this rural population. We identified some conditions that are more common in HIV and others that can be used as indicators of HIV infection.