Health Problem In Uganda Research Articles

Prevalence factors associated with hypertension in Rukungiri district, Uganda--a community-based study.

Hypertension is a growing public health problem in Uganda and Africa as a whole. We conducted a study to determine the prevalence and identify factors associated withy hypertension among residents of the rural district of Rukungiri, Uganda. A community-based cross-sectional study design was used to conduct this study. Between January and February 2006, a random sample of consenting district residents, aged 20 years or older were enrolled to participate in this study. Trained research assistants administered a standardized questionnaire and performed the physical measurements. The questionnaire collected data on demographics, social economic and exposure history to various potential risk factors for hypertension. Hypertension was defined as systolic blood pressure (BP) equal or greater than 140mmHg and/or diastolic BP equal or greater than 90mmHg, and/or being on regular anti-hypertensive therapy. Logistic regression analysis was used to identify factors associated with hypertension. Of the 842 study participants, 252 were hypertensive. The age-standardized prevalence of hypertension was 30.5%, with a 95% Confidence Interval (CI) of 26.6 - 34.3%. Factors found to be associated with hypertension included: past alcohol use, Odds Ratio (OR)=2.28, [1.42 - 3.64], present alcohol use OR=1.64 [1.12 - 2.43], being overweight OR=1.95 [1.37 - 2.79], obesity OR=5.07 [2.79 - 9.21], female sex OR=1.44 [1.03 - 2.06], having attained tertiary education OR=1.91 [1.03 - 3.56], and older age OR=1.42 [1.27 - 1.59]). The prevalence of hypertension in this rural Ugandan district is relatively high. The findings confirm the growing concern about hypertension as a public health problem in Uganda. More studies are however required to determine the distribution and determinants of hypertension in other parts of the country.

Analysis of risk factors for T. brucei rhodesiensesleeping sickness within villages in south-east Uganda

BackgroundSleeping sickness (HAT) caused by T.b. rhodesiense is a major veterinary and human public health problem in Uganda. Previous studies have investigated spatial risk factors for T.b. rhodesiense at large geographic scales, but none have properly investigated such risk factors at small scales, i.e. within affected villages. In the present work, we use a case-control methodology to analyse both behavioural and spatial risk factors for HAT in an endemic area.MethodsThe present study investigates behavioural and occupational risk factors for infection with HAT within villages using a questionnaire-based case-control study conducted in 17 villages endemic for HAT in SE Uganda, and spatial risk factors in 4 high risk villages. For the spatial analysis, the location of homesteads with one or more cases of HAT up to three years prior to the beginning of the study was compared to all non-case homesteads. Analysing spatial associations with respect to irregularly shaped geographical objects required the development of a new approach to geographical analysis in combination with a logistic regression model.ResultsThe study was able to identify, among other behavioural risk factors, having a family member with a history of HAT (p = 0.001) as well as proximity of a homestead to a nearby wetland area (p < 0.001) as strong risk factors for infection. The novel method of analysing complex spatial interactions used in the study can be applied to a range of other diseases.ConclusionSpatial risk factors for HAT are maintained across geographical scales; this consistency is useful in the design of decision support tools for intervention and prevention of the disease. Familial aggregation of cases was confirmed for T. b. rhodesiense HAT in the study and probably results from shared behavioural and spatial risk factors amongmembers of a household.

Enhancing nutritional density and quality of banana-soy based complementary diet through substitution with sesame

Although Uganda is well endowed with adequate food supplies, more than one third of the children under the age of five are malnourished and 60% of all deaths of children under five years of age are directly or indirectly attributable to malnutrition. The causes of this public health problem in Uganda are complex and multidisciplinary, but poor quality and quantity of foods given to children play a major role. In this study, we conducted a rat feeding trial experiment in order to explore the potential of a banana-soy based diet optimally incorporated with sesame as a complementary diet to support growth of children. The study applied sensory evaluation and rat feeding trial experiments to investigate the optimum level of sesame incorporation in an earlier formulated bananasoy diet and as well explore the nutritional value of the final diet. Crude protein, ash and energy contents of the formulations were determined using AOAC methods. Data were analyzed using GenStat 5 Release 3.2. Nutrient and energy composition was compared using ANOVA and PER was compared using t-test. Results showed that a mixture of 67% banana, 16.5% soybean and 16.5% sesame flours produced a blend whose proximate analysis, PER and sensory evaluation studies had satisfactory nutritional quality, quantity and optimum organoleptic attributes. There was a high nutritional quality attained when soy and sesame flours were mixed in equal proportions. Therefore optimum incorporation of soybean and sesame in banana based complementary diets not only greatly enhances nutrient density and quality of these diets but also their organoleptic attributes. Feeding children these diets could break the cycle of childhood malnutrition through reduced feeding of starchy gruels that have low energy and protein contents or with undesirable sensory properties. The mixture is also easy to prepare at community level and may be adequate for catch up growth among children recovering from malnutrition. Keywords : Malnutrition, Nutrient Density, Optimization, complementary AJFAND Vol. 8 (1) 2008 pp. 104-117

The Incidence of Induced Abortion in Uganda

Although Uganda's law permits induced abortion only to save a woman's life, many women obtain abortions, often under unhygienic conditions. Small-scale studies suggest that unsafe abortion is an important health problem in Uganda, but no national quantitative studies of abortion exist. A nationally representative survey of 313 health facilities that treat women who have postabortion complications and a survey of 53 professionals who are knowledgeable about the conditions of abortion provision in Uganda were conducted in 2003. Indirect estimation techniques were applied to the data to calculate the number of induced abortions performed annually. Abortion rates, abortion ratios and unintended pregnancy rates were calculated for the nation and its four major regions. Data on contraceptive use and unmet need were obtained from Demographic and Health Surveys. Each year, an estimated 297,000 induced abortions are performed in Uganda, and nearly 85,000 women are treated for complications. Abortions occur at a rate of 54 per 1,000 women aged 15-49 and account for one in five pregnancies. The abortion rate is higher than average in the Central region (62 per 1,000 women), the country's most urban and economically developed region. It is also very high in the Northern region (70 per 1,000). Nationally, about half of pregnancies are unintended; 51% of married women aged 15-49 and 12% of their unmarried counterparts have an unmet need for effective contraceptives. Unsafe abortion exacts a heavy toll on women in Uganda. To reduce unplanned pregnancy and unsafe abortion, and to improve women's health, increased access to contraceptive services is needed for all women.

Sickle cell disease in Uganda: a time for action

To draw attention to the extent of homozygous sickle cell (SS) disease as a public health problem in Uganda where a mean 20% frequency of the sickle cell trait implies that 25,000 babies with SS disease are born each year. To highlight the dangers of applying interventions developed in non-malarial areas to regions where malaria may change the natural history and outcome of sickle cell disease. The published literature from Africa and from the US and Caribbean in populations of African ancestry. The world literature especially, that derived from the US, Caribbean, and equatorial Africa. In non-malarial areas, simple interventions applied early in life have significantly improved survival and the quality of life. Two well documented interventions are pneumococcal prophylaxis and the early parental diagnosis of acute splenic sequestration. The available literature from Africa suggests that neither of these may be appropriate in malarial areas. Manifestations of SS disease differ in malarial areas and it is questionable whether interventions developed in non-malarial areas apply. There is an urgent need to document the causes of death so that locally appropriate interventions may be developed to improve survival. Equally urgent is the need to define the pattern of clinical problems so that models of care may be evolved for use in malarial areas. Without this knowledge, health care planners will not have the information necessary to develop strategies and limited resources may be inappropriately deployed.

Reanalyzing the 1900-1920 sleeping sickness epidemic in Uganda.

Sleeping sickness has long been a major public health problem in Uganda. From 1900 to 1920, more than 250,000 people died in an epidemic that affected the southern part of the country, particularly the Busoga region. The epidemic has traditionally been ascribed to Trypanosoma brucei gambiense, a parasite now confined to central and western Africa. The Busoga region still reports sleeping sickness, although it is caused by T.b. rhodesiense, commonly believed to have spread to Uganda from Zambia in the 1940s. Our analysis of clinical data recorded in the early 1900s shows that the clinical course of sleeping sickness cases during the 1900-1920 epidemic in Uganda was markedly different from T.b. gambiense cases, but similar to T.b. rhodesiense. These findings suggest that T.b. rhodesiense was present in Uganda and contributed to the epidemic. The historic context is reassessed in the light of these data.

Epidemiology and geography of Schistosoma mansoni in Uganda: implications for planning control.

Intestinal schistosomiasis caused by infection with Schistosoma mansoni is a widespread public health problem in Uganda. Although long known to be endemic, its current distribution within the country requires updating of parasitological data to help guide planned control. We report such data collected between 1998 and 2002 from 201 schools and 68 communities across Uganda. In accordance with epidemiological expectation, prevalence and intensity increased with age, peaking at 10-20 years and thereafter declined moderately with age, whereas intensity declined more rapidly with age, and the prevalence of infection in a school was non-linearly related to the mean intensity of infection. We used geographical information systems to map the distribution of infection and to overlay parasitological data with interpolated environmental surfaces. The derived maps indicate both a widespread occurrence of infection and a marked variability in infection prevalence, with prevalence typically highest near the lakeshore and along large rivers. No transmission occurred at altitudes >1400 m or where total annual rainfall was <900 mm; limits which can help estimate the population at risk of schistosomiasis. The results are discussed in reference to the ecology of infection and provide an epidemiological framework for the design and implementation of control efforts underway in Uganda.

The challenge of establishing community-directed treatment with Mectizan in Uganda.

Onchocerciasis is a major public health problem in Uganda, affecting 17 of the country's 39 districts. 1995 data indicate that of the 19 million Ugandans, 1.8 million were at risk of infection and 1.36 million were already infected. 1.3 million Ugandans in 2255 villages are currently being targeted for annual treatment with Mectizan (ivermectin, MSD). 74% of the targeted villages are hyperendemic and 18% are meso-endemic for the disease. The control of onchocerciasis in Uganda through the mass distribution of Mectizan began in the early 1990s, as a result of collaboration between the Ministry of Health and 4 nongovernmental development organizations. With the aim of eliminating onchocerciasis as a public health problem in Uganda, the national program now reaches all communities known to be affected by the disease in all but 1 district, and achieved a mean treatment coverage of 75% in 1995 and 1996. However, with results of a 1996 World Health Organization study suggesting that community-directed treatment should be the main method of onchocerciasis control in Africa, Uganda's national onchocerciasis task force must now reorient its current program from community-based to community-directed treatment. This latter approach gives communities a greater role in distributing Mectizan.