Luwero District Research Articles

Selection and performance of village health teams (VHTs) in Uganda: lessons from the natural helper model of health promotion.

BackgroundCommunity health worker (CHW) programmes have received much attention since the 1978 Declaration of Alma-Ata, with many initiatives established in developing countries. However, CHW programmes often suffer high attrition once the initial enthusiasm of volunteers wanes. In 2002, Uganda began implementing a national CHW programme called the village health teams (VHTs), but their performance has been poor in many communities. It is argued that poor community involvement in the selection of the CHWs affects their embeddedness in communities and success. The question of how selection can be implemented creatively to sustain CHW programmes has not been sufficiently explored. In this paper, our aim was to examine the process of the introduction of the VHT strategy in one rural community, including the selection of VHT members and how these processes may have influenced their work in relation to the ideals of the natural helper model of health promotion.MethodsAs part of a broader research project, an ethnographic study was carried out in Luwero district. Data collection involved participant observation, 12 focus group discussions (FGDs), 14 in-depth interviews with community members and members of the VHTs and four key informant interviews. Interviews and FGD were recorded, transcribed and coded in NVivo. Emerging themes were further explored and developed using text query searches. Interpretations were confirmed by comparison with findings of other team members.ResultsThe VHT selection process created distrust, damaging the programme’s legitimacy. While the Luwero community initially had high expectations of the programme, local leaders selected VHTs in a way that sidelined the majority of the community’s members. Community members questioned the credentials of those who were selected, not seeing the VHTs as those to whom they would go to for help and support. Resentment grew, and as a result, the ways in which the VHTs operated alienated them further from the community. Without the support of the community, the VHTs soon lost morale and stopped their work.ConclusionAs the natural helper model recommends, in order for CHW programmes to gain and maintain community support, it is necessary to utilize naturally existing informal helping networks by drawing on volunteers already trusted by the people being served. That way, the community will be more inclined to trust the advice of volunteers and offer them support in return, increasing the likelihood of the sustainability of their service in the community.

The formicid ant, Plagiolepis sp., as a predator of the coffee twig borer, Xylosandrus compactus

The coffee twig borer (Xylosandrus compactus Eichhoff) is an economically important pest of Robusta coffee in Uganda. In this study, a formicid ant, Plagiolepis sp., found in X. compactus galleries at the National Coffee Research Institute in 2014, was evaluated for potential to provide biological control of the twig borer. In a Petri dish feeding bioassay, Plagiolepis sp. preyed on all stages of X. compactus except adults within 24h. In field bioassays where Plagiolepis sp. was caged over X. compactus-infested twigs for one month in muslin sleeves, the predator colonized pest galleries and eliminated all life stages of X. compactus as opposed to the untreated control. In a survey of Plagiolepis sp. in 11 districts of eastern, central and western Uganda, the ant was present in nine of the districts with highest levels of colonization (over 18%) of X. compactus galleries in Luwero district in the central Lake Victoria crescent agroecological zone. These results appear to confirm that Plagiolepis sp. is an indigenous predator of X. compactus which invades pest galleries and feeds on the pest in the field. For prospective utilization of Plagiolepis sp. as a biological control agent of X. compactus, studies on the biology of Plagiolepis sp., its mass rearing protocols and factors favoring its proliferation in the field are highly recommended.

Managing Ebola from rural to urban slum settings: experiences from Uganda.

Five outbreaks of ebola occurred in Uganda between 2000-2012. The outbreaks were quickly contained in rural areas. However, the Gulu outbreak in 2000 was the largest and complex due to insurgency. It invaded Gulu municipality and the slum- like camps of the internally displaced persons (IDPs). The Bundigugyo district outbreak followed but was detected late as a new virus. The subsequent outbreaks in the districts of Luwero district (2011, 2012) and Kibaale (2012) were limited to rural areas. Detailed records of the outbreak presentation, cases, and outcomes were reviewed and analyzed. Each outbreak was described and the outcomes examined for the different scenarios. Early detection and action provided the best outcomes and results. The ideal scenario occurred in the Luwero outbreak during which only a single case was observed. Rural outbreaks were easier to contain. The community imposed quarantine prevented the spread of ebola following introduction into Masindi district. The outbreak was confined to the extended family of the index case and only one case developed in the general population. However, the outbreak invasion of the town slum areas escalated the spread of infection in Gulu municipality. Community mobilization and leadership was vital in supporting early case detection and isolations well as contact tracing and public education. Palliative care improved survival. Focusing on treatment and not just quarantine should be emphasized as it also enhanced public trust and health seeking behavior. Early detection and action provided the best scenario for outbreak containment. Community mobilization and leadership was vital in supporting outbreak control. International collaboration was essential in supporting and augmenting the national efforts.

Violence against primary school children with disabilities in Uganda: a cross-sectional study.

Background150 million children live with disabilities globally, and a recent systematic review found 3 to 4 times the levels of violence versus non-disabled children in high income countries. However, almost nothing is known about violence against disabled children in lower income countries. We aim to explore the prevalence, patterns and risk factors for physical, sexual and emotional violence among disabled children attending primary school in Luwero District, Uganda.MethodsWe performed a secondary analysis of data from the baseline survey of the Good Schools Study. 3706 children and young adolescents aged 11-14 were randomly sampled from 42 primary schools. Descriptive statistics were computed and logistic regression models fitted.Results8.8% of boys and 7.6% of girls reported a disability. Levels of violence against both disabled and non-disabled children were extremely high. Disabled girls report slightly more physical (99.1% vs 94.6%, p = 0.010) and considerably more sexual violence (23.6% vs 12.3%, p = 0.002) than non-disabled girls; for disabled and non-disabled boys, levels are not statistically different. The school environment is one of the main venues at which violence is occurring, but patterns differ by sex. Risk factors for violence are similar between disabled and non-disabled students.ConclusionsIn Uganda, disabled girls are at particular risk of violence, notably sexual violence. Schools may be a promising venue for intervention delivery. Further research on the epidemiology and prevention of violence against disabled and non-disabled children in low income countries is urgently needed.

Water and climate variability in developing countries: the case of Uganda

Water safety and climate mitigation measures are global concerns. In this study, climate variability and related health implications were examined. The data included 11,101 outpatient records in the Luwero district from the Ugandan Ministry of Health database, the records of 2,358 outpatients connected with water-related health risks linked to climate variability (diseases such as cholera, typhoid, acute diarrhoea and dysentery) from seven sub-county health centres, monthly mean rainfall data for 30 years (1977–2007), and information from 90 households that harvest rainwater near the local health units. Using a logistic regression, the analysis controlled for the following list of social factors that potentially influence capabilities: personal characteristics (education), cultural norms, the capacity to cope with shocks, seasonal variation, societal favouritism and community segregation. Integrated water management, man-made induced activities and information on effects of climate variability were important in mitigation planning. Young people, including those under the age of 18, were significantly more vulnerable than people of other ages to water-related health risks linked to climate variability. Although both the young and the elderly are susceptible to waterborne illnesses, the findings reveal a link to climate variability, which is inadequately emphasised. We recommend persistence in climate mitigation measures and control against water-related risks.

School Violence, Mental Health, and Educational Performance in Uganda

Violence against children from school staff is anecdotally common in low- and middle-income countries, but data on prevalence and associations with mental health and educational outcomes are lacking. We report data from a cross-sectional survey conducted in June and July 2012 in Luwero District, Uganda. Forty-two primary schools representing 80% of students in the district were randomly selected; 100% agreed to participate. The International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool-Child Institutional; Strengths and Difficulties Questionnaire; and reading, spelling, and math tests were administered. We present descriptive statistics and logistic regression models, accounting for the complex sampling scheme used in the survey. We surveyed 3706 students and 577 school staff members; 93.3% (SE 1.0%) of boys and 94.2% (SE 1.6%) of girls attending primary school reported lifetime experience of physical violence from a school staff member, and >50% reported experience in the past week. Past-week physical violence was associated with increased odds of poor mental health and, for girls, double the odds of poor educational performance (adjusted odds ratio = 1.78, 95% confidence interval = 1.19-2.66). For boys, significant interactions were present. Despite a ban on corporal punishment in Ugandan schools since 1997, the use of violence against students is widespread and associated with poor mental health and educational performance. School violence may be an important but overlooked contributor to disease burden and poor educational performance in low- and middle-income settings.

The impact of HIV/AIDS on the elderly and proposed strategies to curb the effect

This paper presents policy issues from a study that was conducted by members of the Uganda National Advocacy team on HIV/AIDS Care from July to December 2012. The aim was to explore HIV/AIDS challenges among older persons and strategies that could be used to curb the effect. Respondents were purposively selected older persons from rural and urban areas of Pallisa, Kamwenge, Luwero and Budaka districts. It was a qualitative study. Data was collected using focus group discussions and in-depth interviews with 40 elderly persons at health center IVs. And an interview schedule was administered to 4 key informants who included health personnel working at these health center IVs. Respondents were selected with the help of community leaders and Village Health teams. Others were accessed through snowballing. Elderly persons provided data on HIV/AIDS-related challenges and proposed strategies that could be used to curb the disease. Key respondents provided data on strategies that could be adopted to curb the effects of the epidemic. Data was analyzed using content analysis and descriptive methods. Results showed that older persons were faced with policy issues regarding HIV/AIDS. They included lack of access to ART treatment due to long distances to the health facilities were ART is available, high costs, stigma and isolation by society, negative attitude of the community and nutrition challenges among others. Key words: Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), older persons, challenges, policy strategies, Uganda.

Comparative <i>Brucella abortus</i> antibody prevalence in cattle under contrasting husbandry practices in Uganda

A study was conducted in the Luwero and Nakasongola districts in central Uganda to determine and compare the prevalence and distribution of antibodies against Brucella abortus in cattle under contrasting husbandry practices, using two serological tests. Three hundred and fifteen serum samples were systematically sampled from 29 farms and subsequently tested using the Rose Bengal plate test (RBPT) and Indirect Antibody Enzyme Linked Immunosorbent Assay (I-ELISA). The overall prevalence of antibodies against Brucella abortus in the Nakasongola and Luwero districts was 2.4% and 4.7% on RBPT, compared with 1.2% and 3.34 % on I-ELISA. There was no significant difference between the results obtained by RBPT and indirect antibody ELISA (p > 0.05). It was noted that antibodies against Brucella abortus were widely spread over different farms regardless of the cattle grazing system (p > 0.05). Based on the findings, it is feasible to use RBPT as a cheaper screening alternative for brucellosis. A comprehensive national brucellosis study should be undertaken to study the epidemiology and prevalence of brucellosis in Uganda.

The Good Schools Toolkit to prevent violence against children in Ugandan primary schools: study protocol for a cluster randomised controlled trial.

BackgroundWe aim to evaluate the effectiveness of the Good School Toolkit, developed by Raising Voices, in preventing violence against children attending school and in improving child mental health and educational outcomes.Methods/designWe are conducting a two-arm cluster randomised controlled trial with parallel assignment in Luwero District, Uganda. We will also conduct a qualitative study, a process evaluation and an economic evaluation. A total of 42 schools, representative of Luwero District, Uganda, were allocated to receive the Toolkit plus implementation support, or were allocated to a wait-list control condition. Our main analysis will involve a cross-sectional comparison of the prevalence of past-week violence from school staff as reported by children in intervention and control primary schools at follow-up.At least 60 children per school and all school staff members will be interviewed at follow-up. Data collection involves a combination of mobile phone-based, interviewer-completed questionnaires and paper-and-pen educational tests. Survey instruments include the ISPCAN Child Abuse Screening Tools to assess experiences of violence; the Strengths and Difficulties Questionnaire to measure symptoms of common childhood mental disorders; and word recognition, reading comprehension, spelling, arithmetic and sustained attention tests adapted from an intervention trial in Kenya.DiscussionTo our knowledge, this is the first study to rigorously investigate the effects of any intervention to prevent violence from school staff to children in primary school in a low-income setting. We hope the results will be informative across the African region and in other settings.Trial registrationclinicaltrials.gov NCT01678846

Reemerging Sudan Ebola Virus Disease in Uganda, 2011

Two large outbreaks of Ebola hemorrhagic fever occurred in Uganda in 2000 and 2007. In May 2011, we identified a single case of Sudan Ebola virus disease in Luwero District. The establishment of a permanent in-country laboratory and cooperation between international public health entities facilitated rapid outbreak response and control activities.

SPREAD OF XANTHOMONAS CAMPESTRIS PV. MUSACEARUM IN BANANA (MUSA SPP.) PLANTS FOLLOWING INFECTION OF THE MALE INFLORESCENCE

ISHS IV International Symposium on Banana: International Conference on Banana and Plantain in Africa: Harnessing International Partnerships to Increase Research Impact SPREAD OF XANTHOMONAS CAMPESTRIS PV. MUSACEARUM IN BANANA (MUSA SPP.) PLANTS FOLLOWING INFECTION OF THE MALE INFLORESCENCE

A randomised, double-blind field trial of ivermectin alone and in combination with albendazole for the treatment of Mansonella perstans infections in Uganda

The effect of a single dose of ivermectin alone (150-200microg/kg body weight) or in combination with albendazole (total of 400mg) in Mansonella perstans infection was assessed in a randomised, double-blind field trial in two endemic communities in Mukono and Luwero districts of Uganda. No side effects were observed or reported during the first 7 days after treatment. The effect on microfilaraemia was analysed among individuals with >or=20 microfilariae (mf) per 100mul of blood at baseline, who took the treatment and who attended follow-up examinations at 6 months and 12 months after treatment (48 and 46 in Mukono and 48 and 40 in Luwero for the ivermectin and combination treatment, respectively). In both communities, the combination treatment appeared slightly more effective than ivermectin alone, but the difference was not statistically significant. Both drug regimens were more effective in Luwero than in Mukono, probably owing to different diets in the two areas. However, in general both treatment regimens in both communities had limited effect on microfilarial intensities, and only one individual (given combination treatment in Luwero) was mf-negative at 6 months and 12 months after treatment. [ClinicalTrials.gov identifier: NCT00215280].

Mansonella perstans filariasis in Uganda: patterns of microfilaraemia and clinical manifestations in two endemic communities

Surveys for Mansonella perstans infection and potentially related clinical manifestations were undertaken in two endemic communities in Mukono and Luwero districts of Uganda where no other human filarial infections are transmitted. A sensitive and accurate counting chamber method was used for quantifying microfilaraemia in 100microl of finger-prick blood. Among 575 and 991 examined individuals aged >or=1 year in the two communities, the overall microfilariae (mf) prevalence was significantly higher in Mukono (76.5%) than in Luwero (57.7%). As early as age 1-4 years, 40.6% and 20.5% of the children were mf-positive. Prevalences increased rapidly with increasing age to reach 89.2% and 81.4% in the 15-19 years age group and then remained high in subsequent age groups. The geometric mean mf intensity among mf-positive individuals was slightly higher in the Mukono community (32.4mf/100microl) than in the Luwero community (29.9mf/100microl), and this parameter increased with age in both communities. No obvious associations were observed between various clinical parameters and M. perstans microfilaraemia in any of the study communities. The observed patterns of microfilaraemia and the lack of obvious visible clinical manifestations suggest that the host's regulatory responses are downregulated in M. perstans infections. [ClinicalTrials.gov identifier: NCT00215280].

Use of antenatal care, maternity services, intermittent presumptive treatment and insecticide treated bed nets by pregnant women in Luwero district, Uganda

BackgroundTo reduce the intolerable burden of malaria in pregnancy, the Ministry of Health in Uganda improved the antenatal care package by including a strong commitment to increase distribution of insecticide-treated nets (ITNs) and introduction of intermittent preventive treatment with sulphadoxine-pyrimethamine for pregnant women (IPTp-SP) as a national policy in 2000. This study assessed uptake of both ITNs and IPTp-SP by pregnant women as well as antenatal and maternity care use with the aim of optimizing their delivery.Methods769 post-partum women were recruited from a rural area of central Uganda with perennial malaria transmission through a cross-sectional, community-based household survey in May 2005.ResultsOf the 769 women interviewed, antenatal clinic (ANC) attendance was high (94.4%); 417 (57.7%) visiting initially during the 2nd trimester, 242 (33.5%) during the 3rd trimester and 266 (37.1%) reporting ≥ 4 ANC visits. About 537 (71%) and 272 (35.8%) received one or ≥ 2 IPTp-SP doses respectively. Only 85 (15.8%) received the first dose of IPTp-SP in the 3rd trimester. ITNs were used by 239 (31.3%) of women during pregnancy and 314 (40.8%) delivered their most recent pregnancy outside a health facility. Post-partum women who lacked post-primary education were more likely not to have attended four or more ANC visits (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.2–9.3).ConclusionThese findings illustrate the need to strengthen capacity of the district to further improve antenatal care and maternity services utilization and IPTp-SP uptake. More specific and effective community health strategies to improve effective ANC, maternity services utilization and IPTp-SP uptake in rural communities should be undertaken.

Birth plans and health facility Based delivery in rural Uganda

To evaluate whether the completion of birth plans is associated with delivery in a health facility and the perceptual causes of birth plan completion and health facility based delivery were explored according to a well-tested health behaviour theory. A community survey. Rakai and Luwero districts. A total of 415 (202 in Rakai and 213 in Luwero district) respondents were randomly selected and interviewed using a mixed survey questionnaire composed of open and close-ended questions. Health facility based delivery. The results demonstrate a statistically significant relationship between the completion of birth plans and delivery in a health facility (OR = 1.86, 95% CI =1.1, 3.1). The fear of consequences of delivering at home was found to be an important driving force in promoting the completion of birth plans, thereby indirectly influencing the likelihood of delivery in a health facility. Given the empirical evidence presented here, this study suggests that birth plans are an important tool in improving the rate of health facility based deliveries and thus essential in the fight against maternal mortality in Uganda. It is further recommended that campaigns market the use of birth plans as a way to reduce uncertainty and manage fear and the unknown about pregnancy.

Efforts by Small-Scale Farmers to Maintain Soil Fertility and Their Impacts on Soil Properties, Luwero District, Uganda

ABSTRACT Low soil fertility remains a major reason for rural poverty in sub-Saharan Africa. In light of the need to set priorities and formulate development policies, this study investigates efforts by farmers in central Uganda to maintain soil fertility, factors affecting their capacity to act and impacts on soil fertility parameters. Using questionnaire-based interviews and soil chemical analyses, information from 60 randomly selected farms was collected in four subcounties. Farmers use traditional conservation methods like legumes, crop rotation, cover crops, fallow and agroforestry in addition to applying manure, ash, mineral fertilizers and concoctions to improve soil fertility. Most farmers construct some soil bunds. Limited access to supplies, markets, credit and extension service, labor and organic materials are limitations to their ability to maintain soil fertility. Present application of fertility measures are clearly insufficient and are not reflected in soil fertility parameters.

The Psychological Effects of Gender-Based Violence Following Armed Conflict in Luwero District, Uganda

The Psychological Effects of Gender-Based Violence Following Armed Conflict in Luwero District, Uganda

Resolving human-elephant conflict in Luwero District, Uganda, through elephant translocation

Since the early 1970s migration routes between Queen Elizabeth and Murchison Falls NPs have been increasingly cut off by settlement and agricultural land, and elephant living in the area have become isolated subpopulations. Capture and translocation were chosen as the management option to deal with four adult elephants (2 bulls, 2 cows) involved in crop raiding, property damage, and competition for water in the Luwero area. The animals were anaesthised darted from a helicopter, and were loaded onto trucks and transported Murchison Falls NP. Article describes procedures used in locating, anaesthetizing, loading, transporting , and safely releasing the animals. One of which was radio collared while the other three were paint marked for further monitoring. The work was undertaking by the Kenya Wildlife Service Translocation Team in conjunction with staff for the Uganda Wildlife Authority

Potential of orange and yellow fleshed sweetpotato cultivars for improving vitamin A nutrition in Central Uganda

The potential of orange and yellow fleshed sweetpotato cultivars as a dietary source of Vitamin A in Mpigi and Luwero Districts of central Uganda was evaluated. On-farm agronomic performance, acceptability and b-carotene content of two orange (SPK004 and 316) and two yellow fleshed (Tanzania and 52) sweetpotato cultivars were determined and compared to the farmer's best local cultivars. There were significant differences in yield performance between cultivars with 52 yielding highest. Yields for TZ and SPK004 were comparable to those of best yielding local checks while 316 yielded lowest. Dry matter content of all the cultivars was above 30%. Overall, 52 was the most acceptable to farmers but children prefered SPK 004. b-carotene content of orange fleshed cultivars was higher than that of yellow and white fleshed cultivars. It was concluded that orange fleshed sweetpotato have highest potential for improving Vitamin A nutrition in the study area. Key Words: b-carotene, Ipomoea batatus, sensory acceptability, Uganda, vitamin A malnutrition (African Crop Science Journal 2001 9(1): 309-316)

Population dynamics of ticks on indigenous cattle in a pastoral dry to semi-arid rangeland zone of Uganda.

Studies on seasonality and population dynamics of ticks on indigenous cattle and their crosses (calves) were carried out in Buruli Ranching Scheme, Nabiswera, Luwero district of Uganda on three treatment groups of animals: group 1 (twice a week dipping), group 2 (once a month dipping) and group 3 (no tick control). During this study, four major species of ticks of economic importance were recorded in decreasing order of abundance: Rhipicephalus appendiculatus, Rhipicephalus evertsi evertsi, Amblyomma variegatum and Boophilus decoloratus. Of these ticks, a seasonal pattern of activity was only observed in R. appendiculatus ticks, with peak activities occurring during rainy seasons. Greater numbers of ticks were recorded on cows than calves in the three treatment groups, with the exception of A. variegatum where the reverse occurred. The mean numbers of ticks per animal were highly significantly different (p < 0.01) when group 1 animals were compared with group 2 and 3 animals. However, no significant differences (p > 0.05) were observed in mean tick numbers between group 2 and 3 animals. Highly significant differences (p < 0.01) were observed in mean tick numbers on cows and calves (more than 12 months old) in different calving seasons. The state of lactation only affected tick counts on cows in group 1; significantly more ticks (p < 0.01) were observed in lactating than non-lactating cows. Furthermore, significantly greater (p < 0.05) numbers of ticks (with the exception of B. decoloratus) were recorded during the second year of study (March 1992-May 1993) than the first year (January 1991-February 1992), despite lower rainfall during the former period.