Ugandan Population Research Articles

Pesticide monitoring of vulnerable populations in Uganda and South Africa

BACKGROUND AND AIM: Weak governance of pesticides and poor knowledge, attitude and agricultural practices result in farmers and their families being exposed to multiple pesticides in Africa. What are the important routes of exposure and are there interconnections between family members? How can we quantify exposure to multiple pesticides in these most vulnerable populations? METHODS: First, we provide results from our systematic literature review on pesticide environmental contamination, human exposure and health issues on the African continent. Second, we show pesticide exposure situations from two fundamentally different farming systems using longitudinal data from our PESTROP cohort study in Uganda with smallholder farmers and from our CapSA cohort study investigating children in areas with large-scale agriculture production in South Africa. Finally, pesticide exposure assessment tools to monitor multiple pesticides will be highlighted (e.g., passive air sampling, questionnaire-based exposure algorithms, urinary biomarkers and wristbands). RESULTS:Only from few countries in Africa research studies are available on pesticide exposure. Also, most research studies focus on organochlorine pesticides, while research on currently used pesticide classes is lacking or only crude exposure assessments are done (e.g., sprayers vs non-sprayers). This is problematic as in our two cohorts, we showed that (high) exposure to multiple currently used pesticides over time is the reality for farmers and their children (also to pesticides that are already banned in the EU). CONCLUSIONS:We developed low-cost and context-specific assessments to monitor exposure to multiple pesticides in remote areas in Africa. Such tools could be used in intervention studies to monitor their efficiency to reduce exposure and resulting health risks from multiple currently used pesticides. This is done, for example, within our new initiative “African Pesticide Intervention Study (APSENT)” where we use these assessment tools, bring stakeholders together and thereby reduce pesticide exposure and associated risks. KEYWORDS: Africa, Pesticide, Exposure, urine, wristband, air

An assessment of the knowledge, practices and resources during the delivery of malaria health care services among private health care practitioners: a cross section study in the Mid-Western Region of Uganda

BackgroundApproximately 50 % of the population in Uganda seeks health care from private facilities but there is limited data on the quality of care for malaria in these facilities. This study aimed to document the knowledge, practices and resources during the delivery of malaria care services, among private health practitioners in the Mid-Western region of Uganda, an area of moderate malaria transmission.MethodsThis was a cross sectional study in which purposive sampling was used to select fifteen private-for-profit facilities from each district. An interviewer-administered questionnaire that contained both quantitative and open-ended questions was used. Information was collected on availability of treatment aides, knowledge on malaria, malaria case management, laboratory practices, malaria drugs stock and data management. We determined the proportion of health workers that adequately provided malaria case management according to national standards.ResultsOf the 135 health facilities staff interviewed, 61.48 % (52.91–69.40) had access to malaria treatment protocols while 48.89 % (40.19–57.63) received malaria training. The majority of facilities, 98.52 % (94.75–99.82) had malaria diagnostic services and the most commonly available anti-malarial drug was artemether-lumefantrine, 85.19 % (78–91), followed by Quinine, 74.81 % (67–82) and intravenous artesunate, 72.59 % (64–80). Only 14.07 % (8.69–21.10) responded adequately to the acceptable cascade of malaria case management practice. Specifically, 33.33 % (25.46–41.96) responded correctly to management of a patient with a fever, 40.00 % (31.67–48.79) responded correctly to the first line treatment for uncomplicated malaria, whereas 85.19 % (78.05–90.71) responded correctly to severe malaria treatment. Only 28.83 % submitted monthly reports, where malaria data was recorded, to the national database.ConclusionsThis study revealed sub-optimal malaria case management knowledge and practices at private health facilities with approximately 14 % of health care workers demonstrating correct malaria case management cascade practices. To strengthen the quality of malaria case management, it is recommended that the NMCD distributes current guidelines and tools, coupled with training; continuous mentorship and supportive supervision; provision of adequate stock of essential anti-malarials and RDTs; reinforcing communication and behavior change; and increasing support for data management at private health facilities.

A Struggle for Survival: Meaning of Late Life in a Rural District in Uganda: A Qualitative Study.

Background: Between 2015 and 2050, the aging population of Uganda (aged 50 years and older) will be nearly doubled. Therefore, later-life problems have become an area of increasing research and policy interest. This study aimed at exploring how aging people living in extreme poverty in a low-income country experience their everyday life and what kind of meaning systems employed by them to understand and cope with their living conditions.Methods: We conducted a qualitative interview with 14 participants in the Buikwe district. In this interview, 11 women and 3 men were included, and a thematic analysis was employed for data processing and analysis.Results: Unanimously, all participants reported their condition as extreme poverty. The key informants (KIs) emphasized respect from descendants and the community as a foundation for a meaningful later life. In contrast, this aspect has been ever mentioned by no caregivers but by only one care-receiver. The willingness/ability of children to support the elderly who are in need of support formed a major part of the reflections of care-receivers, which would be decisive for their position in the society and the respect they would receive. In addition, both Christianity and traditional beliefs as well as beliefs in witchcraft and ancestral spirits were employed as a basis for actions and reflections.Discussion: The question arises whether life in extreme poverty conditions can be perceived as meaningful. Respect was mentioned as fundamental by the KIs, thereby giving priority to social relations as the most meaningful factor for living a meaningful life. The ability and willingness of the possible descendants for support as the focus of care-receivers might be a more down-to-earth description of this aspect but without using the same level of abstraction. For the majority, due to their belief system did not serve as a source of consolation their main focus was on social relationships for support. To improve the wellbeing of the old people, their sense of meaning must be restored through a system, guaranteeing the coverage of basic needs and measures to restore dignity through a reintegration in both community and congregations. Social service agencies who are targeting the elderly people need to work toward this objective.

Prevalence and factors associated with ocular morbidity among prisoners of Luzira prison (Uganda)

BackgroundGlobally, ocular morbidity has emerged as a major public concern with at least 2.2 billion people having vision impairment or blindness. Prisoners (inmates) tend to have limited access to health care especially eye health, and as a result some conditions may go undiagnosed or mismanaged. With the increasing prison population in Uganda and in the face of limited facilities, little is known about the prevalence and factors associated with ocular morbidity amongst inmates of Luzira prison.MethodThis was a descriptive cross-sectional study conducted on inmates of Luzira prison. The study included both male (334) and female (33) inmates using the proportionate stratified random sampling. Data on social demographic characteristics, medical, imprisonment factors and ocular assessment was collected using a questionnaire. All complete data was entered using an Epidata version 3.1 entry template, and logistic regression was used to determine associated factors.ResultsOverall, a total of 367 inmates were examined consisting of 334 (91%) males and 33(8.9%) females. The male-to-female ratio was 10:1 with ages ranging from 18 to 76 years. The mean age being 39 years (SD + 13.4) and the overall ocular morbidity was found to be 49%. The most common ocular morbidity included; presbyopia (27.4%), allergic conjunctivitis (19.6%) and cataracts (11.4%). Other disorders included; refractive errors, pterygia, optic atrophy and vitamin A deficiency. There was a statistically significant relationship between ocular morbidity and age (OR 11.96, CI 0.85–2.74), trauma (OR 5.21, CI 1.52–17.87), non-prison food (OR 0.45, CI 0.26–0.79).ConclusionThe prevalence of ocular morbidity among inmates was found to be high and significantly associated with age, trauma and having meals besides prison food. A fully functional eye unit established within the prison, and timely referral of complicated cases would help in offering quality eye services to the inmates.

Qualitative Assessment of Barriers and Facilitators of PrEP Use Before and After Rollout of a PrEP Program for Priority Populations in South-central Uganda.

Uganda piloted HIV pre-exposure prophylaxis (PrEP) for priority populations (sex workers, fishermen, truck drivers, discordant couples) in 2017. To assess facilitators and barriers to PrEP uptake and adherence, we explored perceptions of PrEP before and experiences after rollout among community members and providers in south-central Uganda. We conducted 75 in-depth interviews and 12 focus group discussions. We analyzed transcripts using a team-based thematic framework approach. Partners, family, peers, and experienced PrEP users provided adherence support. Occupational factors hindered adherence for sex workers and fishermen, particularly related to mobility. Pre-rollout concerns about unskilled/untrained volunteers distributing PrEP and price-gouging were mitigated. After rollout, awareness of high community HIV risk and trust in PrEP effectiveness facilitated uptake. PrEP stigma and unexpected migration persisted as barriers. Community-initiated, tailored communication with successful PrEP users may optimize future engagement by addressing fears and rumors, while flexible delivery and refill models may facilitate PrEP continuation and adherence.

Evaluation of the BioFire® FilmArray® Meningitis/Encephalitis panel in an adult and pediatric Ugandan population

BackgroundMeningitis causes significant mortality in sub-Saharan Africa and limited diagnostics exist. We evaluated the utility of the BioFire® FilmArray® Meningitis/Encephalitis multiplex PCR panel (BioFire ME) in HIV-infected adults and HIV-infected and uninfected children presenting with suspected meningitis in Uganda. MethodsWe tested cerebrospinal fluid (CSF) using a stepwise meningitis diagnostic algorithm including BioFire ME. We determined the diagnostic performance of BioFire ME for cryptococcal meningitis, using cryptococcal antigen (CrAg) and CSF culture as reference standards, and assessed other central nervous system (CNS) pathogens identified by the panel. ResultsWe evaluated 328 adult and 42 pediatric CSF specimens using BioFire ME. Of the adult CSF samples tested, 258 were obtained at baseline, and 70 were obtained from repeat lumbar punctures in cryptococcal meningitis. For Cryptococcus, sensitivity was 82%, specificity was 98%, PPV was 98%, and NPV was 79% in baseline specimens using CSF CrAg as the reference standard. Among follow-up specimens, a negative BioFire ME for Cryptococcus predicted CSF culture sterility with 84% NPV. Overall sensitivity was decreased at low fungal burdens: 29% for 0–99 Cryptococcus CFU/mL compared to 94% for ≥100 CFU/mL in baseline specimens. Other pathogens detected included E. Coli, H. influenzae, S. pneumoniae, CMV, enterovirus, HSV, HHV-6, and VZV. Two specimens tested positive for S. pneumoniae and one for Cryptococcus in the pediatric population. ConclusionsMultiplex PCR is a promising rapid diagnostic test for meningitis in adults and children in resource-limited settings. Cryptococcus at low fungal burdens in CSF may be missed by BioFire ME.

An econometric analysis of modernized cereal production in reducing multidimensional poverty in Uganda, 1975-2014

Purpose This study aims to develop an econometric analysis of how modern agriculture can be a fundamental instrument for reducing the levels of multidimensional poverty in Uganda. It demonstrates the importance of agriculture in reducing inequalities amongst the poor while focusing on the relationship between increasing productions from modern agricultural practices and the poverty level across the country. Design/methodology/approach The study explores Box–Jenkins approach to cereal production data with the use of econometric analysis as the main tool to determine the implications of modern agricultural practices in Uganda. Most poor people around the world are in marginalized rural environments, and agriculture provides for their livelihoods. This makes agricultural development crucial for reducing multidimensional poverty on a large scale and needs development within agriculture to be enhanced. Education, health and standard of living are the three dimensions considered from the weighted indicators, amounting to 30%, to be categorized poor in the three dimensions. Findings Modernization of agriculture is an ultimate solution to multidimensional poverty reduction in Uganda through employment generation and the effects of food prices. Shreds of evidence support the theories that agricultural incomes together with the actual wages increase with a general rise in the rural non-agricultural economy. Results depict a close correlation between national income and GDP per capita which is a very significant indication that more application of agricultural technology would lead to a sub sequential improvement of livelihoods engaged in agricultural practices. Originality/value Agriculture remains a vital sector that employs a greater portion of the population in Uganda’s economy. Major roles have been played by the sector in the economy including employment opportunities, rural household incomes, food supplies and a reduction in poverty from a multidimensional front. Exploring the behavior of poverty level using modern agriculture as an indicator and its relationship with the poverty level arising from improved agricultural practices could provide a meaningful display of variation in poverty across the regions at the country level.

Antibacterial, antioxidant, and sun protection potential of selected ethno medicinal plants used for skin infections in Uganda

BackgroundRural populations in Uganda rely heavily on medicinal plants for the treatment of bacterial skin infections. However, the efficacy of these medicinal plants for their pharmacological action is not known. The study aimed at evaluating the antibacterial, antioxidant, and sun protection potential of Spermacoce princeae, Psorospermum febrifugum, Plectranthus caespitosus, and Erlangea tomentosa extracts.MethodsThe plant samples were extracted by maceration sequentially using hexane, dichloromethane, ethyl acetate, methanol, and distilled water. Antibacterial activity of each extract was carried out using an agar well diffusion assay against Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Klebsiella pneumonie, Streptococcus pyogenes, and Salmonella typhi. Acute dermal toxicity of the aqueous extract of S. princeae and P. febrifugum, and E. tomentosa was assessed in young adult healthy Wistar albino rats at a dose of 8000 and 10,000 mg/kg body weight. The antioxidant activity of each extract was carried out using a 1,1-diphenyl-2-picryl-hydrazyl (DPPH) radical scavenging assay. The sun protection factor was determined using Shimadzu UltraViolet-Visible double beam spectrophotometer between 290 and 320 nm.ResultsThe plant extracts showed good antibacterial activity against the tested bacterial strains with minimum inhibitory concentration (MIC) ranging between 3.12 and 12.5 mg/ml. There was no significant change in the levels of creatinine, alanine aminotransferase, and aspartate aminotransferase in the rats even at a higher dose of 10,000 mg/kg, which was related to the results of biochemical analysis of the blood samples from the treated and control groups. The aqueous and methanol extracts of S. princeae showed potential antioxidant properties, with half maximal inhibitory concentration (IC50) values of 59.82 and 61.20 μg/ml respectively. The organic and aqueous extracts of P. caespitosus showed high levels of protection against Ultraviolet light with sun protection potential values ranging between 30.67 and 37.84.ConclusionsThe study demonstrated that the selected medicinal plants possessed good antibacterial, antioxidant, and sun protection properties. Therefore, the plants are alternative sources of antibacterial, antioxidant, and sun protection agents in managing bacterial skin infections.

Genetic diversity and genetic relatedness in Plasmodium falciparum parasite population in individuals with uncomplicated malaria based on microsatellite typing in Eastern and Western regions of Uganda, 2019\u20132020

BackgroundGenetic diversity and parasite relatedness are essential parameters for assessing impact of interventions and understanding transmission dynamics of malaria parasites, however data on its status in Plasmodium falciparum populations in Uganda is limited. Microsatellite markers and DNA sequencing were used to determine diversity and molecular characterization of P. falciparum parasite populations in Uganda.MethodsA total of 147 P. falciparum genomic DNA samples collected from cross-sectional surveys in symptomatic individuals of 2–10 years were characterized by genotyping of seven highly polymorphic neutral microsatellite markers (n = 85) and genetic sequencing of the Histidine Rich Protein 2 (pfhrp2) gene (n = 62). ArcGIS was used to map the geographical distribution of isolates while statistical testing was done using Student's t-test or Wilcoxon's rank-sum test and Fisher’s exact test as appropriate at P ≤ 0.05.ResultsOverall, 75.5% (95% CI 61.1–85.8) and 24.5% (95% CI14.2–38.9) of parasites examined were of multiclonal (mixed genotype) and single clone infections, respectively. Multiclonal infections occurred more frequently in the Eastern region 73.7% (95% CI 48.8–89.1), P < 0.05. Overall, multiplicity of infection (MOI) was 1.9 (95% CI 1.7–2.1), P = 0.01 that was similar between age groups (1.8 vs 1.9), P = 0.60 and regions (1.9 vs 1.8), P = 0.43 for the < 5 and ≥ 5 years and Eastern and Western regions, respectively. Genomic sequencing of the pfhrp2 exon2 revealed a high level of genetic diversity reflected in 96.8% (60/62) unique sequence types. Repeat type AHHAAAHHATD and HRP2 sequence Type C were more frequent in RDT−/PCR + samples (1.9% vs 1.5%) and (13% vs 8%), P < 0.05 respectively. Genetic relatedness analysis revealed small clusters of gene deleted parasites in Uganda, but no clustering with Eritrean parasites.ConclusionHigh level of genetic diversity of P. falciparum parasites reflected in the frequency of multiclonal infections, multiplicity of infection and variability of the pfhrp2 gene observed in this study is consistent with the high malaria transmission intensity in these settings. Parasite genetic analysis suggested spontaneous emergence and clonal expansion of pfhrp2 deleted parasites that require close monitoring to inform national malaria diagnosis and case management policies.

Circulating levels of angiogenic factors and their association with preeclampsia among pregnant women at Mulago National Referral Hospital in Uganda.

Preeclampsia (PE) is a major cause of maternal and new-born morbidity and mortality. Angiogenic factors contribute a major role in the vascular dysfunction associated with PE. We investigated the circulating levels of vascular endothelial growth factor (VEGF), placental growth factor (PlGF) and soluble Feline McDonough Sarcoma (fms)-like tyrosine kinase-1 (sFlt1), their association with PE and diagnostic performance of disease among pregnant women in Uganda. Using a case-control study design, 106 women with PE and 106 with normal pregnancy were enrolled. Demographic and clinical characteristics, and anticoagulated blood samples were collected from participants. Plasma VEGF, PlGF and sFlt1 levels were measured using Luminex and enzyme linked immunosorbent assays (ELISA). Conditional logistic regression was used to explore association of angiogenic factors with PE and receiver operating characteristic analysis was performed to investigate PE diagnostic performance. Levels of VEGF and PIGF were significantly lower in cases compared to controls (VEGF: median = 0.71 pg/ml (IQR = 0.38-1.11) Vs 1.20 pg/ml (0.64-1.91), p-value<0.001 and PlGF: 2.20 pg/ml (1.08-5.86) Vs 84.62 pg/ml (34.00-154.45), p-value<0.001). Plasma levels of sFlt1 were significantly higher in cases than controls (median = 141.13 (71.76-227.10) x103 pg/ml Vs 19.86 (14.20-29.37) x103 pg/ml). Increasing sFlt1 levels were associated with increased likelihood of PE (aOR = 4.73; 95% CI, 1.18-19.01; p-value = 0.0287). The sFlt1/PlGF ratio and sFlt1 had a better performance for diagnosis of PE, with AUC = 0.95 (95% CI, 0.93-0.98) followed by PlGF with AUC = 0.94 (95% CI, 0.91-0.97). Therefore, sFlt1, sFlt1/PlGF ratio and PlGF are potential candidates for incorporation into algorithms for PE diagnosis in the Ugandan population.

Effectiveness of genomic selection for improving provitamin A carotenoid content and associated traits in cassava.

Global efforts are underway to develop cassava with enhanced levels of provitamin A carotenoids to sustainably meet increasing demands for food and nutrition where the crop is a major staple. Herein, we tested the effectiveness of genomic selection (GS) for rapid improvement of cassava for total carotenoids content and associated traits. We evaluated 632 clones from Uganda’s provitamin A cassava breeding pipeline and 648 West African introductions. At harvest, each clone was assessed for level of total carotenoids, dry matter content, and resistance to cassava brown streak disease (CBSD). All clones were genotyped with diversity array technology and imputed to a set of 23,431 single nucleotide polymorphic markers. We assessed predictive ability of four genomic prediction methods in scenarios of cross-validation, across population prediction, and inclusion of quantitative trait loci markers. Cross-validations produced the highest mean prediction ability for total carotenoids content (0.52) and the lowest for CBSD resistance (0.20), with G-BLUP outperforming other models tested. Across population, predictions showed low ability of Ugandan population to predict the performance of West African clones, with the highest predictive ability recorded for total carotenoids content (0.34) and the lowest for CBSD resistance (0.12) using G-BLUP. By incorporating chromosome 1 markers associated with carotenoids content as independent kernel in the G-BLUP model of a cross-validation scenario, prediction ability slightly improved from 0.52 to 0.58. These results reinforce ongoing efforts aimed at integrating GS into cassava breeding and demonstrate the utility of this tool for rapid genetic improvement.

HIV sero-positivity and risk factors for ischaemic and haemorrhagic stroke in hospitalised patients in Uganda: A prospective-case-control study

ObjectivesWe examined HIV sero-positivity and risk factors in patients admitted with ischaemic stroke (IS) and haemorrhagic stroke (HS) in Kampala, Uganda. Study designWe conducted a matched case-control study between December 2016 and December 2018 ​at ​St Francis Hospital, Nsambya. MethodsThe study population comprised of stroke cases (adults aged ≥18 years with IS or HS confirmed by neuroimaging) and controls (age- and sex-matched stroke-free adults aged ≥18 years who were recruited from the same hospital as the cases). A comprehensive assessment for sociodemographic, lifestyle and clinical factors was performed using the World Health Organization (WHO) STEP-wise approach to Surveillance (STEPS) for stroke risk factor surveillance. We used conditional logistic regression to identify risk factors associated with IS or HS. ResultsWe enrolled 137 matched case-control pairs; 48 (35%) were men, and the mean ages were 62.4 years (SD ​± ​14.8) for cases and 61.1 years (SD ​± ​14.1) for controls. Of stroke patients, 86 (63%) had IS and 51 (37%) had HS. Overall, HIV sero-positivity was 10% among stroke cases versus 7% among controls. HIV sero-positivity was not significantly associated with stroke (unadjusted odds ratio [uOR] ​= ​1.49, 95% confidence interval [CI] 0.59–3.78). A self-reported family history of diabetes mellitus was associated with an increased risk of all stroke (adjusted odds ratio [aOR] ​= ​4.41, 95% CI 1.47–13.2), as well as for IS and HS separately (aOR ​= ​3.66, 95% CI 1.09–12.4 and aOR ​= ​4.99, 95% CI 1.02–24.4, respectively). High blood pressure (≥140/90 ​mmHg) was associated with an increased risk of all stroke (aOR ​= ​12.3, 95% CI 42–44.1), and this was also true for IS and HS individually (aOR ​= ​6.48, 95% CI 1.15–36.7 and aOR ​= ​5.63, 95% CI 1.74–18.2, respectively). ConclusionsNo association was found between HIV sero-positivity and stroke occurrence among Ugandan stroke patients. Hypertension and a self-reported family history of diabetes mellitus were significant risk factors for both IS and HS. Interventions to reduce hypertension and diabetes mellitus in the Ugandan population are urgently required. Much larger studies are required to demonstrate if any association exists between HIV and stroke.

Global Disparities in Skin Cancer Services at HIV Treatment Centers across 29 Countries

Global Disparities in Skin Cancer Services at HIV Treatment Centers across 29 Countries

Developing an online food composition database for an Indigenous population in south-western Uganda.

To develop an online food composition database of locally consumed foods among an Indigenous population in south-western Uganda. Using a community-based approach and collaboration with local nutritionists, we collected a list of foods for inclusion in the database through focus group discussions, an individual dietary survey and markets and shops assessment. The food database was then created using seven steps: identification of foods for inclusion in the database; initial data cleaning and removal of duplicate items; linkage of foods to existing generic food composition tables; mapping and calculation of the nutrient content of recipes and foods; allocating portion sizes and accompanying foods; quality checks with local and international nutritionists; and translation into relevant local languages. Kanungu District, south-western Uganda. Seventy-four participants, 36 Indigenous Batwa and 38 Bakiga, were randomly selected and interviewed to inform the development of a food list prior the construction of the food database. We developed an online food database for south-western Uganda including 148 commonly consumed foods complete with values for 120 micronutrients and macronutrients. This was for use with the online dietary assessment tool myfood24. Of the locally reported foods included, 56 % (n 82 items) of the items were already available in the myfood24 database, while 25 % (n 37 items) were found in existing Ugandan and Tanzanian food databases, 18 % (n 27 items) came from generated recipes and 1 % (n 2 items) from food packaging labels. Locally relevant food databases are sparse for African Indigenous communities. Here, we created a tool that can be used for assessing food intake and for tracking undernutrition among the communities living in Kanungu District. This will help to develop locally relevant food and nutrition policies.

Discovery and fine-mapping of kidney function loci in first genome-wide association study in Africans.

Genome-wide association studies (GWAS) of kidney function have uncovered hundreds of loci, primarily in populations of European ancestry. We have undertaken the first continental African GWAS of estimated glomerular filtration rate (eGFR), a measure of kidney function used to define chronic kidney disease (CKD). We conducted GWAS of eGFR in 3288 East Africans from the Uganda General Population Cohort (GPC) and replicated in 8224 African Americans from the Women’s Health Initiative. Loci attaining genome-wide significant evidence for association (P < 5 × 10−8) were followed up with Bayesian fine-mapping to localize potential causal variants. The predictive power of a genetic risk score (GRS) constructed from previously reported trans-ancestry eGFR lead single nucleotide polymorphism (SNPs) was evaluated in the Uganda GPC. We identified and validated two eGFR loci. At the glycine amidinotransferase (GATM) locus, the association signal (lead SNP rs2433603, P = 1.0 × 10−8) in the Uganda GPC GWAS was distinct from previously reported signals at this locus. At the haemoglobin beta (HBB) locus, the association signal (lead SNP rs141845179, P = 3.0 × 10−8) has been previously reported. The lead SNP at the HBB locus accounted for 88% of the posterior probability of causality after fine-mapping, but did not colocalise with kidney expression quantitative trait loci. The trans-ancestry GRS of eGFR was not significantly predictive into the Ugandan population. In the first GWAS of eGFR in continental Africa, we validated two previously reported loci at GATM and HBB. At the GATM locus, the association signal was distinct from that previously reported. These results demonstrate the value of performing GWAS in continental Africans, providing a rich genomic resource to larger consortia for further discovery and fine-mapping. The study emphasizes that additional large-scale efforts in Africa are warranted to gain further insight into the genetic architecture of CKD.

HIV-related stigma and its association with HIV transmission risk behaviors among boda boda motorcyclists in Mbarara Municipality, southwestern Uganda.

Background: Key populations have a disproportionate burden of HIV compared with the general population. HIV-related stigma has been recognized as a major barrier to HIV prevention and treatment efforts. It remains unclear whether HIV-related stigma is a significant driver of HIV transmission risk behavior among boda boda (motorcycle taxi) riders, a key population in Uganda. Methods: We conducted a cross-sectional study among boda boda motorcyclists in Mbarara Municipality of southwestern Uganda. Using multistage sampling, we recruited participants aged 18-59years who had been riding for at least 6months. The primary explanatory variable of interest was HIV-related stigma, measured using the 7-item STRIVE scale and dichotomized at "no stigma" versus "any stigma." Self-reported HIV transmission risk behaviors included: condomless sexual intercourse, sexual intercourse under the influence of alcohol, having non-primary sexual partners, and sexual intercourse with a commercial sex worker. We used multivariable logistic regression to estimate the association between HIV-related stigma and HIV transmission risk behavior. Results: We enrolled 401 boda boda motorcyclists. All were men. Most [330 (82%)] were classified as having HIV-related stigma, particularly among younger men aged 18-29years. One hundred and thirty-two (34%) participants reported their last sexual encounter was with a non-primary partner, 153 (39%) did not know the serostatus of their last sexual partner, and 138 (36%) reported sexual intercourse with a sex worker in the past 6months. In multivariable logistic regression, HIV-related stigma (adjusted odds ratio [aOR] = 1.88, 95% CI: 1.06-3.34) had a statistically significant association with any HIV transmission risk behavior. Men who reported either minimal alcohol use (aOR = 1.81, 95% CI: 1.07-2.95) or harmful alcohol use (aOR = 3.5, 95% CI: 1.92-6.54), compared with men who reported no alcohol use, also reported greater odds of HIV transmission risk behavior. Conclusions: HIV transmission risk behavior is common among boda boda motorcyclists in the municipality and is associated with both HIV-related stigma and alcohol use. Interventions aimed at reducing HIV-related stigma and alcohol use may potentially reduce the high rates of HIV transmission risk behavior in this key population.

Prospective verification of sonographic fetal weight estimators among term parturients in Uganda

BackgroundAccuracy of fetal weight estimation by ultrasound is essential in making decisions on the time and mode of delivery. There are many proposed formulas for fetal weight estimation such as Hadlock 1, Hadlock 2, Hadlock 3, Hadlock 4 and Shepard. What best applies to the Ugandan population is not known since no verification of any of the formulas has been done before. The primary aim of this study was to determine the accuracy of sonographic estimation of fetal weight using five most commonly used formulas, and analyze formula variations for different weight ranges.MethodsThis was a hospital based prospective cohort study at Mulago National Referral Hospital, Kampala, Uganda. A total of 356 pregnant women who consented and were within 3 days of birth were enrolled. Prenatal ultrasound fetal weight determined by measuring the biparietal diameter, head circumference, abdominal circumference, femoral length, and then was compared with actual birth weight.ResultsThe overall accuracy of Hadlock 1, Hadlock 2, Hadlock 3, Hadlock 4 and Shepard formula were 66.9, 73.3, 77.3, 78.4 and 69.7% respectively. All Hadlocks showed significant mean difference between weight estimates and actual birth weight (p < 0.01) whereas Shepard formula did not [p - 0.2], when no stratification of fetal weights was done. However, all Hadlocks showed a none significant (p-values > 0.05) mean difference between weight estimates and actual birth weight when the actual birth weight was ≥4000.0 g. Shepard weight estimates showed a none significant mean difference when actual birth weight was < 4000 g. Bland-Altman graphs also showed a better agreement of weight estimated by Shepard formula and actual birth weights.ConclusionAll the five formulas were accurate at estimating actual birth weights within 10% accuracy. However, this accuracy varied with the fetal birth weight. Shepard was more accurate in estimating actual birth weights < 4000 g whereas all Hadlocks were more accurate when the actual birthweight was ≥4000 g.

Diversity of KIR genes and their HLA-C ligands in Ugandan populations with historically varied malaria transmission intensity

BackgroundMalaria is one of the most serious infectious diseases in the world. The malaria burden is greatly affected by human immunity, and immune responses vary between populations. Genetic diversity in KIR and HLA-C genes, which are important in immunity to infectious diseases, is likely to play a role in this heterogeneity. Several studies have shown that KIR and HLA-C genes influence the immune response to viral infections, but few studies have examined the role of KIR and HLA-C in malaria infection, and these have used low-resolution genotyping. The aim of this study was to determine whether genetic variation in KIR and their HLA-C ligands differ in Ugandan populations with historically varied malaria transmission intensity using more comprehensive genotyping approaches.MethodsHigh throughput multiplex quantitative real-time PCR method was used to genotype KIR genetic variants and copy number variation and a high-throughput real-time PCR method was developed to genotype HLA-C1 and C2 allotypes for 1344 participants, aged 6 months to 10 years, enrolled from Ugandan populations with historically high (Tororo District), medium (Jinja District) and low (Kanungu District) malaria transmission intensity.ResultsThe prevalence of KIR3DS1, KIR2DL5, KIR2DS5, and KIR2DS1 genes was significantly lower in populations from Kanungu compared to Tororo (7.6 vs 13.2%: p = 0.006, 57.2 vs 66.4%: p = 0.005, 33.2 vs 46.6%: p < 0.001, and 19.7 vs 26.7%: p = 0.014, respectively) or Jinja (7.6 vs 18.1%: p < 0.001, 57.2 vs 63.8%: p = 0.048, 33.2 vs 43.5%: p = 0.002, and 19.7 vs 30.4%: p < 0.001, respectively). The prevalence of homozygous HLA-C2 was significantly higher in populations from Kanungu (31.6%) compared to Jinja (21.4%), p = 0.043, with no significant difference between Kanungu and Tororo (26.7%), p = 0.296.ConclusionsThe KIR3DS1, KIR2DL5, KIR2DS5 and KIR2DS1 genes may partly explain differences in transmission intensity of malaria since these genes have been positively selected for in places with historically high malaria transmission intensity. The high-throughput, multiplex, real-time HLA-C genotyping PCR method developed will be useful in disease-association studies involving large cohorts.

Starting and Operating a Public Cardiac Catheterization Laboratory in a Low Resource Setting: The Eight-Year Story of the Uganda Heart Institute Catheter Laboratory

Background:Low- and-middle-income-countries (LMICs) currently bear 80% of the world’s cardiovascular disease (CVD) mortality burden. The same countries are underequipped to handle the disease burden due to critical shortage of resources. Functional cardiac catheterization laboratories (cath labs) are central in the diagnosis and management of CVDs. Yet, most LMICs, including Uganda, fall remarkably below the minimum recommended standards of cath lab:population ratio due to a host of factors including the start-up and recurring costs.Objectives:To review the performance, challenges and solutions employed, lessons learned, and projections for the future for a single cath lab that has been serving the Ugandan population of 40 million people in the past eight years.Methods:A retrospective review of the Uganda Heart Institute cath lab clinical database from 15 February 2012 to 31 December 2019 was performed.Results:In the initial two years, this cath lab was dependent on skills transfer camps by visiting expert teams, but currently, Ugandan resident specialists independently operate this lab. 3,542 adult and pediatric procedures were conducted in 8 years, including coronary angiograms and percutaneous coronary interventions, device implantations, valvuloplasties, and cardiac defect closures, among others. There was a consistent expansion of the spectrum of procedures conducted in this cath lab each year. The initial lack of technical expertise and sourcing for equipment, as well as the continual need for sundries present(ed) major roadblocks. Government support and leveraging existing multi-level collaborations has provided a platform for several solutions. Sustainability of cath lab services remains a significant challenge especially in relation to the high cost of sundries and other consumables amidst a limited budget.Conclusion:A practical example of how centers in LMIC can set up and sustain a public cardiac catheterization laboratory is presented. Government support, research, and training collaborations, if present, become invaluable leverage opportunities.

Genetic diversity of native and cultivated Ugandan Robusta coffee (Coffea canephora Pierre ex A. Froehner): Climate influences, breeding potential and diversity conservation.

Wild genetic resources and their ability to adapt to environmental change are critically important in light of the projected climate change, while constituting the foundation of agricultural sustainability. To address the expected negative effects of climate change on Robusta coffee trees (Coffea canephora), collecting missions were conducted to explore its current native distribution in Uganda over a broad climatic range. Wild material from seven forests could thus be collected. We used 19 microsatellite (SSR) markers to assess genetic diversity and structure of this material as well as material from two ex-situ collections and a feral population. The Ugandan C. canephora diversity was then positioned relative to the species’ global diversity structure. Twenty-two climatic variables were used to explore variations in climatic zones across the sampled forests. Overall, Uganda’s native C. canephora diversity differs from other known genetic groups of this species. In northwestern (NW) Uganda, four distinct genetic clusters were distinguished being from Zoka, Budongo, Itwara and Kibale forests A large southern-central (SC) cluster included Malabigambo, Mabira, and Kalangala forest accessions, as well as feral and cultivated accessions, suggesting similarity in genetic origin and strong gene flow between wild and cultivated compartments. We also confirmed the introduction of Congolese varieties into the SC region where most Robusta coffee production takes place. Identified populations occurred in divergent environmental conditions and 12 environmental variables significantly explained 16.3% of the total allelic variation across populations. The substantial genetic variation within and between Ugandan populations with different climatic envelopes might contain adaptive diversity to cope with climate change. The accessions that we collected have substantially enriched the diversity hosted in the Ugandan collections and thus contribute to ex situ conservation of this vital genetic resource. However, there is an urgent need to develop strategies to enhance complementary in-situ conservation of Coffea canephora in native forests in northwestern Uganda.