Ugandan Population Research Articles

Low consumption of fruits and vegetables among adults in Uganda: findings from a countrywide cross-sectional survey

IntroductionAdequate consumption of fruits and vegetables has protective benefits against development of coronary heart disease, hypertension and chronic obstructive pulmonary disease. However, approximately 2.7 million deaths annually can be attributed to inadequate fruit and vegetable consumption. We analyzed data from a countrywide survey in Uganda, to estimate the prevalence of adequate fruit and/ or vegetable consumption, and identify associated factors.MethodsData were collected using the World Health Organization STEPwise approach to surveillance, a standard approach to surveillance of risk factors for Non Communicable Diseases. Fruit and vegetable consumption was assessed by asking participants the number of days in a typical week they eat fruits or vegetables and the number of servings eaten in one of those days. Adequate fruit and/ or vegetable consumption was defined as consuming 5 or more servings of fruits and/ or vegetables per day in a typical week. We used modified Poisson regression analysis to estimate prevalence risk ratios (PRRs) and identify factors associated with eating 5 or more servings of fruits and/ or vegetables per day, per week.ResultsOf 3962 participants, 484 (12.2%) consumed 5 or more servings of fruits and/ or vegetables per day in a typical week. Participants who were married or cohabiting were more likely to consume at least 5 servings of fruits and/ or vegetables per day in a typical week compared with those who had never been married PRR = 1.51 [95% CI 1.07–2.14]. Compared with participants from Western region, those from Central region were more likely to consume 5 or more servings of fruits and/ or vegetables per day in a typical week, PRR = 3.54 [95% CI 2.46–5.10] as were those from Northern, PRR = 2.90 [95% CI 2.00–4.23] and Eastern regions PRR = 1.60 [95% CI 1.04–2.47].ConclusionsFruit and vegetable consumption in Uganda is low and does not differ significantly across social and demographic characteristics, except marital status and geographical region of residence. There is a need to develop and strengthen policies that promote adequate consumption of fruits and vegetables in the Ugandan population.

Shelter from the storm: Somali migrant networks in Uganda between international business and regional geopolitics

ABSTRACTRecent years have seen a dramatic increase in the Somali population in Uganda. This spike reflects a new development in the history of Somali mobility in East Africa, shaped both by crises and by opportunities, from which sophisticated transnational and translocal strategies have emerged. In this article, we draw attention to these strategies to understand continuity and change in Somali migrant networks in Kampala, highlighting the dual significance of Uganda both as a safe haven and as a stepping stone for upward social mobility and business expansion across the region and beyond. By describing the entanglement of needs and aspirations driving the mobility and livelihood strategies of Somali refugees, students and entrepreneurs, we argue that the historical trajectory of the Somali community in Uganda over the past 30 years has been shaped by the interaction of pre-existing linkages and an institutional framework defined by a mix of donor-oriented policies and presidential patronage. We identify three moments in which Museveni’s ability to ‘manage donors’ perceptions’ has had implications for the economic, demographic and political configuration of the Somali diaspora in Uganda: the economic liberalisation of the 1990s; the 2006 Refugee Act; and the 2007 deployment of UPDF in Uganda.

First-line HIV treatment failures in non-B subtypes and recombinants: a cross-sectional analysis of multiple populations in Uganda

BackgroundOur understanding of HIV-1 and antiretroviral treatment (ART) is strongly biased towards subtype B, the predominant subtype in North America and western Europe. Efforts to characterize the response to first-line treatments in other HIV-1 subtypes have been hindered by the availability of large study cohorts in resource-limited settings. To maximize our statistical power, we combined HIV-1 sequence and clinical data from every available study population associated with the Joint Clinical Research Centre (JCRC) in Uganda. These records were combined with contemporaneous ART-naive records from Uganda in the Stanford HIVdb database.MethodsTreatment failures were defined by the presence of HIV genotype records with sample collection dates after the ART start dates in the JCRC database. Drug resistances were predicted by the Stanford HIVdb algorithm, and HIV subtype classification and recombination detection was performed with SCUEAL. We used Bayesian network analysis to evaluate associations between drug exposures and subtypes, and binomial regression for associations with recombination.ResultsThis is the largest database of first-line treatment failures (n=1724) in Uganda to date, with a predicted statistical power of 80% to detect subtype associations at an odds ratio of ge 1.2. In the subset where drug regimen data were available, we observed that use of 3TC was associated with a higher rate of first line treatment failure, whereas regimens containing AZT and TDF were associated with reduced rates of failure. In the complete database, we found limited evidence of associations between HIV-1 subtypes and treatment failure, with the exception of a significantly lower frequency of failures among A/D recombinants that comprised about 7% of the population. First-line treatment failure was significantly associated with reduced numbers of recombination breakpoints across subtypes.ConclusionsExpanding access to first-line ART should confer the anticipated public health benefits in Uganda, despite known differences in the pathogenesis of HIV-1 subtypes. Furthermore, the impact of ART may actually be enhanced by frequent inter-subtype recombination in this region.

Adaptability of a U.S. purple-fleshed sweetpotato breeding population in Uganda

Purple-fleshed sweetpotato varieties are important for their nutraceutical value due primarily to their high anthocyanin content. These varieties also often have high dry matter content preferred by consumers and processors in sub-Saharan Africa. However, improved purple-fleshed sweetpotatoes are not available in Uganda. This study was conducted to evaluate the adaptability of purple-fleshed sweetpotato genotypes for storage root yield, dry matter and anthocyanin content in Uganda. A bi-parental population of 159 clones from the cross NCP06-020 NC09-188 introduced to Uganda from North Carolina State University was evaluated with three local checks in two sites and two seasons in Uganda. The trials were planted in two locations using alpha lattice design with two replicates and five sweetpotato vine cuttings per genotype. Storage roots and vines were harvested after five months and the agronomic characteristics were recorded. Dry matter and anthocyanin content of storage roots were analysed after harvesting. The mean storage root yield of clones across the two locations was 37.8 t/ha and 24.2 t/ha in the first season (2015A) and second season (2015B); respectively, with an overall mean of 31.0 t/ha. Storage root dry matter content ranged from 21.5 to 33.7% across locations and seasons with an overall mean of 29.1%. Storage root anthocyanin content across the two locations ranged from 0 to 12.6 mg/100g FW with the overall mean of 3.9 mg/100g FW. A total of ten genotypes showed significantly stable performance (P <= 0.001) across two locations and two seasons. Highly significant difference between genotypes for dry matter content, anthocyanin content and total storage root yields revealed significant genetic variability among the tested genotypes, which can be exploited for future crop improvement.

Impaired renal function in a rural Ugandan population cohort

Background: Kidney disease is an important cause of morbidity and mortality globally. However, there are limited data on the prevalence of impaired kidney function in sub-Saharan Africa. We aimed to determine the prevalence of reduced kidney function and associated factors in a rural Ugandan population. Methods: We undertook a study of a representative sample of the General Population Cohort in South-western Uganda. We systematically collected data on cardiovascular disease risk factors, anthropometric measurements and blood tests including haemoglobin, HIV, HbA1c and serum creatinine. The estimated glomerular filtration rate (eGFR) was calculated using the CKD-Epi formula, without the race component of the equation. Results: A total of 5,979/6,397 (93.5%) participants had valid creatinine results. The mean age was 39 years (Range: 16-103 years) and 3,627 (60.7%) were female. HIV prevalence was 9.7% and about 40% of the population were pre-hypertensive or hypertensive. The mean serum creatinine level was 0.75 mg/dl (95% CI 0.74–0.75), and the average eGFR was 109.3 ml/min/1.73 m2 (95% CI 108.8–109.9). The overall prevalence of eGFR &lt;60 ml/min/1.73 m2 was 1.64% (98/5,979) (95% CI 1.34–1.99). Additionally, 4,792 (80.2%) were classified as normal eGFR (≥90 ml/min/1.73 m2), 1,089 (18.2%) as low eGFR (60–89 ml/min/1.73 m2), 91 (1.52%) as moderately reduced eGFR (30–59 ml/min/1.73 m2), 4 (0.07%) as severely reduced eGFR (15-29 ml/min/1.73 m2), and 3 (0.05%) classified as having kidney failure (eGFR &lt;15 ml/min/1.73 m2). When age-standardised to the WHO Standard Population the prevalence of eGFR&lt;60 ml/min/1.73 m2 was 1.79%. Age above 35 years and the presence of hypertension (OR 2.86, 95% CI 1.15-7.08) and anaemia (OR 2.14, 95% CI 1.12-4.09) were associated with eGFR&lt;60 ml/min/1.73 m2. Conclusion: In a systematic survey of people in rural Uganda, we found a substantial proportion had eGFR&lt;60 ml/min/1.73 m2, and this was strongly associated with high blood pressure and anaemia.

Genotyping of 49-plex autosomal SNP panel in Iranian Turkmens ethnic group.

A total of 94 unrelated individuals from Turkmens ethnic group in Iran were typed for forty-nine of the autosomal single nucleotide polymorphisms (SNPs) in the SNPforID 52plex using the SNaPshot assay. Allele frequencies are presents for the 49 SNPs. No deviation from Hardy-Weinberg equilibrium (HWE) was observed in all but one of the 49 SNP systems and no significant linkage disequilibrium was detected for any SNP pairs. FIS and FST were estimated. A statistically significant global FST value was obtained when Turkmens ethnic group were compared with other 20 populations in Turkey, Israel, Pakistan, India, China, Taiwan, Japan, Thailand, Siberia, Algeria, Somali, Uganda, Mozambique, Angola, Nigeria, Russia, Slovenia, Sweden, France and Spain. All but 11 pairwise FST values were statistically significant. Multidimensional scaling plot drawn based on the pairwise FST values showed that the Turkmens ethnic grouped with populations geographically close to Iran and other Middle-Eastern populations. The cumulative values for the match probability using the 49 SNPs was 5.65 × 10-19 consistent to a combined power of discrimination of >99.99999% and the mean exclusion probability was 99.95%.

Dental age estimation using radiographic assessment of third molar eruption among 10-20-year-old Ugandan population.

Aim:This study aimed at establishing the age for third molar eruption among Ugandans aged 10–20 years.Materials and Methods:This was a cross-sectional study comprising 471 male and 541 female patients attending Mulago Dental Clinic. Patients’ orthopantomographs were assessed for third molar eruption as described by Olze et al. Age was summarized using means/SD. Jaw and sex differences were assessed using Student's t-test.Results:Complete eruption (Stage D) ranged between 13 and 20 years. The mean age at complete eruption for girls and boys was 17.5–18 years and 18.2–18.6 years, respectively. Mean age was statistically significantly (P < 0.05) lower among girls compared to boys for all third molar teeth (#18, #28, #38, and #48). The difference in mean eruption times between girls and boys was −0.62 (95% confidence interval: 0.2–1.0, P = 0.006). At 18 years, 40% or 41% maxillary and 52% or 53% mandibular molars were completely erupted. There were statistically significant differences in eruption between the sexes and jaws for all teeth (P < 0.05).Conclusions:Given the fact that the percentage of erupted third molars by age 18 was found to be <50% on an average in this Ugandan population, we should reconsider the use of third molar eruption as a definitive tool for age estimation in this population.

Consequences of Climate Variation on Malaria Incidence in Uganda

Introduction: Temperature and rainfall are assumed to play an important role in the transmission of malaria. According to Zhou simultaneous analysis of the long-term time series of meteorological and parasitological data are critically needed to understand the effects of climate on malaria incidence. However, it would be more plausible to assess the effect of climate variation on the malaria incidence since increase or decrease in the number of malaria cases does not quantify the disease frequency. Objective: This study therefore, seeks to examine the consequences of variation in climatic factors such as temperature and rainfall on the malaria incidence among the Ugandan population. Methods: To account for variation and dynamics in monthly malaria incidence among the Ugandan population, data on environmental factors like minimum and maximum temperature, and rainfall were obtained from Uganda National Meteorological Authority (UNMA) while monthly malaria counts for the period (2006-2016) were obtained from Ministry of Health (MoH). Dynamically complete models were used to simultaneously investigate the impact of environmental factors on monthly malaria incidence in the population. Findings: Findings revealed that the long-run impact of three months successive one percent increase in maximum temperature would result into an 8.1% reduction in monthly malaria incidence. Similarly, three months successive one percent increase in minimum temperature would increase monthly malaria incidence by about 16.7% in the long-run. The impact of rainfall was also significant in that successive one percent three months increase in rainfall would reduce malaria incidence by about 14% in the long-run. Conclusion: Increasing maximum temperature is associated with a reduction in malaria incidence while increasing minimum temperature is associated with an increase in monthly malaria incidence. Lastly, increasing amount of rainfall is associated with a reduction in monthly malaria incidence. Recommendations: In order to lower the incidence of malaria among the population, it’s imperative that malaria control and preventive interventions consider environmental modifications that lower minimum temperature and increase the amount of rainfall. These interventions include land use methods such as conversion of land from forests to settlements and agricultural activities, wetlands for settlements and other economic activities.

Socio-economic Inequality in Stunting among Children Aged 6-59 Months in a Ugandan Population Based Cross-sectional Study

Socio-economic status is an important predictor of stunting, however published population based studies on socio-economic inequalities in stunting among children under-five years of age is scarce in Uganda. Data from the 2016 Uganda Demographic and Health Survey was used to identify possible socio-economic inequalities in stunting among 3941 children aged 6-59 months. Multivariate binary logistic regression models were fitted to calculate the odds ratios and their corresponding 95% confidence intervals for stunting by maternal formal education and household wealth index. The overall prevalence of stunting among children was 30.1%. The risk of stunting was higher among children whose mothers had no formal education (OR: 4.35; 95% CI, 2.45-7.71), attained primary (OR: 2.74 95% CI, 1.62-4.63) and secondary level education (OR: 2.30 95% CI, 1.34-3.96) compared to those whose mothers attained tertiary level education. Similarly higher risk of stunting was found among children that lived in the poorest (OR: 1.78 95% CI, 1.23-2.59), poorer (OR: 1.88; 95% CI, (1.28-2.74), middle (OR: 1.91, 95% CI, 1.31-2.77) and richer households (OR: 1.60; 95% CI, 1.10-2.32) compared to those in the richest households. Socio-economic differences in stunting among children under-five years of age were found. Targeting stunting prevention interventions to less affluent mother-child dyads and households might be important in reducing social inequalities in stunting among children under-five years of age in Uganda.

A Case of TASO Tororo Surge Strategy: Using Double Layered Screening to Increase the Rate of Identification of New HIV Positive Clients in the Community

Introduction: HIV testing services is the entry point to HIV prevention, care, treatment, and support services. According to Uganda Population HIV impact assessment preliminary report released in 2018, 72.5% of people living with HIV in Uganda knew their status, which is below the UNAIDS target of 90%. We proposed a double layered screening of the population using the Ministry of Health HIV Testing Services (HTS) screening tool to identify more HIV positives and start them on treatment. The objective of this study was to assess the impact of the double layered screening approach on HIV test yield. Methods: A double layered screening approach involved using community and technical teams from TASO Tororo HIV clinic through the surge strategy. The community team (first layer) comprised of expert clients, local council 1, market and church leaders who were trained on how to screen the people in the community using the HTS screening tool. The technical team (second layer) comprised of medical personnel and counselors who subjected all people mobilized and screened by the community team to a second layered screening before offering an HIV test. We compared proportions of HIV test yields before and after the implementation of the double layered HTS strategy using proportions test and we assessed the impact of the double layered screening using a difference in difference (DID) evaluation method. Results; There was a general increase in HIV test yield from 4.75% with single screening (period: January-March 2018) to 12.25% with double screening (period: April – June 2018) (P<0.001). The increase was more in males (from 3.51% to 11.06%) than in females (from 6.36% to 13.31%) and this difference was significant (P=0.035). The increase in HIV test yield did not differ by age (P=0.060), by marital status (P=0.606) or by first time tester (P=0.167), Conclusion: The double layered screening before HIV test could be an effective strategy to maximize HIV test yield in the general population, which if scaled up can save huge resources, time and help focus on actual targets for HIV testing services, leading to early attainment of the UNAIDS 1st target of 90-90-90.

Impaired renal function in a rural Ugandan population cohort

Background: Kidney disease is an important cause of morbidity and mortality globally. However, there are limited data on the prevalence of impaired kidney function in sub-Saharan Africa. We aimed to determine the prevalence of reduced kidney function and associated factors in a rural Ugandan population. Methods: We undertook a study of a representative sample of the General Population Cohort in South-western Uganda. We systematically collected data on cardiovascular disease risk factors, anthropometric measurements and blood tests including haemoglobin, HIV, HbA1c and serum creatinine. The estimated glomerular filtration rate (eGFR) was calculated using the CKD-Epi equation, without the race component of the equation. Results: A total of 5,979/6,397 (93.5%) participants had valid creatinine results. The mean age was 39 years (Range:16-103 years) and 3,627 (60.7%) were female. HIV prevalence was 9.7% and about 40% of the population were pre-hypertensive or hypertensive. The mean serum creatinine level was 0.75 mg/dl (95% CI 0.74–0.75), and the average eGFR was 109.3 ml/min/1.73 m 2 (95% CI 108.8–109.9). The overall prevalence of eGFR <60 ml/min/1.73 m 2 was 1.64% (98/5,979) (95% CI 1.34–1.99). Additionally, 4,792(80.2%) were classified as normal eGFR (≥90 ml/min/1.73 m 2), 1,089(18.2%) as low eGFR (60–89 ml/min/1.73 m 2), 91(1.52%) as moderately reduced eGFR (30–59 ml/min/1.73 m 2), 4(0.07%) as severely reduced eGFR (15-29 ml/min/1.73 m 2), and 3(0.05%) classified as having kidney failure (eGFR<15 ml/min/1.73 m 2). When age-standardised to the WHO Standard Population the prevalence of eGFR<60 ml/min/1.73 m 2 was 1.79%. Age above 35 years and the presence of hypertension (OR 2.86, 95% CI 1.15-7.08) and anaemia (OR 2.14, 95% CI 1.12-4.09) were associated with eGFR<60 ml/min/1.73 m 2. Conclusion: In a systematic survey of people in rural Uganda, we found a substantial proportion had eGFR<60 ml/min/1.73 m 2. More population based studies are needed to further characterize kidney disease in sub-Saharan Africa.

Chronic Musculoskeletal Pain, Self-Reported Health and Quality of Life among Older Populations in South Africa and Uganda.

Chronic musculoskeletal pain (CMP) is a serious health concern especially among the elderly population and has significant bearing on health and quality of life. Not much is known about the relationship between chronic pain with self-reported health and quality of life among older populations in low-resource settings. Based on sub-national data from South Africa and Uganda, the present study aimed to explore whether the older population living with CMP report health and quality of life differently compared to those with no CMP complaints. This study was based on cross-sectional data on 1495 South African and Ugandan men and women collected from the SAGE Well-Being of Older People Study. Outcome variables were self-reported physical and mental health and quality of life (QoL). Mental health was assessed by self-reported depressive symptoms during the last 12 months. CMP was assessed by self-reported generalised pain as well as back pain. Multivariable logistic regression models were used to measure the association between health and QoL with CMP by adjusting for potential demographic and environmental confounders. The prevalence of poor self-rated health (61.2%, 95% CI = 51.7, 70.0), depression (37.2%, 95% CI = 34.8, 39.6) and QoL (80.5%, 95% CI = 70.8, 87.5) was considerably high in the study population. Mild/moderate and Severe/extreme generalised pain were reported respectively by 34.5% (95% CI = 28.9, 40.5) and 15.7% (95% CI = 12.2, 19.9) of the respondents, while back pain was reported by 53.3% (95% CI = 45.8, 60.4). The prevalence of both types was significantly higher among women than in men (p < 0.001). In the multivariate analysis, both generalised pain and back pain significantly predicted poor health, depression and QoL, however, it varied between the two different populations. Back pain was associated with higher odds of poor self-rated health [OR = 1.813, 95% CI = 1.308, 2.512], depression [1.640, 95% CI = 1.425, 3.964] and poor QoL [1.505, 95% CI = 1.028, 2.202] in South Africa, but not in Uganda. Compared to having no generalised pain, having Mild/Moderate [OR = 2.309, 95% CI = 1.219, 7.438] and Severe/Extreme [OR = 2.271, 95% CI = 1.447, 4.143] generalised pain was associated with significantly higher odds of poor self-rated health in South Africa. An overwhelmingly high proportion of the sample population reported poor health, quality of life and depression. Among older individuals, health interventions that address CMP may help promote subjective health and quality and life and improve psychological health.

Replacing hospital-based epilepsy clinics with rural epilepsy clinics and education in Uganda: impact on attendance

ABSTRACTBackground: A high proportion of the Ugandan population with epilepsy receive no treatment.Aim: To determine whether introduction of an agreed multidisciplinary guideline and establishment of a local clinic outside the hospital and four rural satellite clinics improved attendance and follow-up by children with epilepsy in Western Uganda.Methods: A multidisciplinary team from Kagando Hospital, Kasese, south-west Uganda created a guideline for the management of epilepsy. A clinic local to the hospital and rural satellite clinics were established.Attendance and follow-up were audited for three months before the intervention. Attendance, follow-up and the cost of the hospital, local and rural clinics were audited 6 months and 5 years post intervention.Results: Pre-intervention, one patient a month attended the free Kagando Hospital epilepsy clinic. Post-intervention, a median of eight patients (range 2–12) attended the local clinic and 100% attended booked follow-up appointments; the cost per clinic was £15 (£1.88 per patient, range 1.25–7.50). A median of 42 (range 15–56) patients per clinic attended the rural clinics and 70% of patients attended follow-up appointments; the cost per clinic was £34 (£0.81 per patient, range 0.61–2.23). Rural clinic attendance was higher than in the hospital clinic (p = 0.007) and in the local clinic (p = 0.004). Five years post-intervention, the attendance was 44 patients (range 25–85) per rural clinic and the cost per clinic was £34.Conclusions: Rural epilepsy clinics were associated with higher attendance than the hospital or local clinic and the attendance rate remained higher 5 years post-intervention.

Trends of serum phospholipid fatty acids over time in rural Uganda: evidence of nutritional transition?

Non-communicable diseases are projected to become the most common causes of death in Africa by 2030. The impact on health of epidemiological and nutritional transitions in sub-Saharan Africa remains unclear. To assess the trends of dietary fatty acids over time in Uganda, we examined fatty acids in serum collected from individuals in rural south-west Uganda, at three time points over two decades. Independent cross-sectional samples of 915 adults and children were selected from the general population cohort in 1990 (n 281), 2000 (n 283) and 2008 (n 351). Serum phospholipid fatty acids were measured by GC. Multivariate regression analyses were performed to compare the geometric means of fatty acids by time period. Serum fatty acid profiling showed high proportions of SFA, cis-MUFA and industrial trans-fatty acids (iTFA), likely to be biomarkers of high consumption of palm oil and hydrogenated fats. In contrast, proportions of n-6 and n-3 PUFA from vegetable oils and fish were low. From 1990 to 2008, serum phospholipids showed increases in absolute amounts of SFA (17·3 % increase in adults and 26·4 % in children), MUFA (16·7 % increase in adults and 16·8 % in children) and n-6:n-3 PUFA (40·1 % increase in adults and 39·8 % in children). The amount of elaidic acid, iTFA from hydrogenated fats, increased in children (60·1 % increase). In this rural Ugandan population, we show evidence of unfavourable trends over time of dietary fatty acids.

Impaired renal function in a rural Ugandan population cohort

Background: Chronic kidney disease (CKD) is an important cause of morbidity and mortality globally. However, there are limited data on the prevalence of impaired kidney function in sub-Saharan Africa. We aimed to determine the prevalence of CKD and associated factors in a rural Ugandan population. Methods: We undertook a study of a representative sample of the General Population Cohort in South-western Uganda. We systematically collected data on cardiovascular disease risk factors, anthropometric measurements and blood tests for haemoglobin, HIV, HbA1c, Hepatitis B and C and serum creatinine. The estimated glomerular filtration rate (eGFR) was calculated using the CKD-Epi formula, without the race component of the equation. Results: A total of 5,979/6,397 (93.5%) participants had valid creatinine results. The mean age was 39 years (Range: 16-103 years) and 3,627 (60.7%) were female. HIV prevalence was 9.7% and about 40% of the population were pre-hypertensive or hypertensive. The mean serum creatinine level was 0.75 mg/dl (95% CI 0.74–0.75), and the average eGFR was 109.3 ml/min/1.73 m2 (95% CI 108.8–109.9). The overall prevalence of CKD (eGFR &lt;60 ml/min/1.73 m2) was 1.64% (98/5,979) (95% CI 1.34–1.99). Additionally, 4,792 (80.2%) were classified as normal (eGFR ≥90 ml/min/1.73 m2), 1,089 (18.2%) as low (eGFR 60–89 ml/min/1.73 m2), 91 (1.52%) as moderate (eGFR 30–59 ml/min/1.73 m2), 4 (0.07%) as severe (eGFR 15-29 ml/min/1.73 m2), and 3 (0.05%) classified as having kidney failure (eGFR &lt;15 ml/min/1.73 m2). When age-standardised to the WHO Standard Population the prevalence of CKD was 1.79%. Age above 35 years (OR 78.3, 95% CI 32.3–189), and the presence of hypertension (OR 2.98, 95% CI 1.47-6.02) and anaemia (OR 2.47, 95% CI 1.37-4.42) were associated with CKD. Conclusion: We found a substantial prevalence of CKD in rural Uganda, strongly associated with high blood pressure and anaemia.

Variation among banana weevil Cosmopolites sordidus (Germar) populations in Uganda as revealed by AFLP markers and corm damage differences

BackgroundThe banana weevil Cosmopolites sordidus (Germar) is a major production constraint of bananas and plantains (Musa spp.) in the world. Differences in damage levels and pesticide response across regions led to the postulation that there might be considerable variation between banana weevil populations (biotypes) with varying levels of virulence. One of the most sustainable options for banana weevil control is the use of host plant resistance. While new resistant varieties are being developed through both conventional crossbreeding and biotechnology, there is a need to assess the genetic variation of banana weevil populations from eastern, central, southern, southwestern and midwest regions of Uganda to determine whether there are biotypes with different virulence levels. This would help guide new control strategies to target all the possible biotypes. The amplified fragment length polymorphism (AFLP) technique was used to analyze population genetic diversity using four primer combinations (EcoRI/MSeI).ResultsAnalysis of molecular variance results presented no evidence to support significant genetic variability among the banana weevil populations from eastern, central, southern, southwestern and midwest regions. Practically, all the genetic variation was found to reside within populations (97% for sites and 98% for regions), with only approximately 3% and 2% residing among populations of sites and regions, respectively.Conclusions and recommendationsAFLP markers clustered the banana weevils into two distinct populations consequently supporting the hypothesis of possible presence of banana weevil biotypes in Uganda. However, attempts should be made to make follow-up studies on the seemingly unique population of eastern Uganda using more robust molecular techniques to establish whether the eastern Uganda population constitutes a different biotype.

Contrast Between Incidence of Childhood and Adolescent Cancers: Using a Population Based Cancer Registry, Kyadondo County, Uganda: 2009 to 2014

Background: Cancer is relatively rare in childhood compared with later in life. In high-income countries, hematologic malignancies are the most common, then brain tumors and solid tumors. World age-standardized incidence rates in Ireland averaged 142 cases per million children per year, higher than European average and lower than US average. In Africa, distribution of childhood cancers is quite similar, commonest being Kaposi sarcoma (KS), Burkitt's lymphoma, retinoblastoma, leukemia and Hodgkin lymphomas (HL). Among adolescent in Zimbabwe, leukemia has highest incidence rates then osteosarcoma, non-Hodgkin lymphoma (NHL) and KS. Aim: To describe the incidence of cancer among children and adolescents in Kyadondo County, Uganda from 2009 to 2014 which is necessary for planning of cancer control programs. Methods: Descriptive cross-sectional study which involved review of data from Kampala Cancer Registry that gathers information on cancers diagnosed within Kyadondo County (formed by Kampala and Wakiso districts) and analyzed using STATA 13. From 2014 Uganda population census, Kyadondo County had a population of 3,523,910 (32.2% children and 10% adolescents). Study population was children (0-14 years) and adolescents (15-19 years) diagnosed with cancer from January 2009 to December 2014. Results: The spectrum of cancers in adolescents reflects a transition. Carcinomas which are so prevalent in adults occur but at lower frequencies in adolescents. Study results are comparable to others studies indicating that nephroblastoma and retinoblastoma were common among children and not adolescents. Leukaemia and lymphomas cut across both children and adolescents. Conclusion: The spectrum of cancers in adolescents reflects a transition. Carcinomas which are so prevalent in adults occur but at lower frequencies in adolescents. Study results indicate that nephroblastoma and retinoblastoma were common among children and not adolescents. New prospective studies should be done on children and adolescent cancers covering a wide population size. Leukaemia and lymphomas cut across both children and adolescents. National cancer registries should be set up.

Are women in Uganda gaining adequate gestational weight? A prospective study in low income urban Kampala

BackgroundPre-pregnancy weight and weight gained during pregnancy significantly influence maternal and infant health. Little information is available regarding optimal gestational weight gain (GWG) in relation to pre-pregnancy body mass index (BMI) in Uganda. The study aimed at determining gestational weight gain (GWG) in women pregnant for the first and second time.MethodsThe study was prospective cohort study which included 221 HIV negative women pregnant for the first or second time. It was conducted in the antenatal clinic of the directorate of gynecology and obstetrics, Mulago hospital and women were recruited at ≤18 weeks of gestation by dates. Follow up measurements were done at 26 and 36 weeks gestation. Measured maternal height and reported pre-pregnancy weight were used to calculate BMI. Depending on BMI category, GWG was categorized as inadequate, adequate and excessive based on the Uganda Ministry of Health guidelines.ResultsThe participants’ mean ± standard deviation (Sd) age was 20.9 ± 2.7 years and mean ± Sd BMI was 21.40 ± 2.73 kg/m2. None of the participants was obese and 68.8% (n = 132) were pregnant for the first time. The mean ± Sd GWG at time of delivery was 10.58 ± 2.44 kg. Inadequate GWG was recorded in 62.5% (n = 120/192) while only 3.1% (n = 6/192) of the participants gained excessive weight during pregnancy.ConclusionAbout 62% of pregnant women in Kampala did not gain adequate weight during their first/second pregnancy. We recommend that studies be carried out to assess whether the Uganda Ministry of Health recommendations for weight gain during are appropriate for preventing adverse pregnancy outcomes across populations in Uganda.

Estimating the cost and cost-effectiveness for obstetric fistula repair in hospitals in Uganda: a low income country.

In Africa, about 33000 cases of obstetric fistula occur each year. Women with fistula experience debilitating incontinence of urine and/or faeces and are often socially ostracized. Worldwide, Uganda ranks third among countries with the highest burden of obstetric fistula. Obstetric fistula repair competes for scarce resources with other healthcare interventions in resource-limited settings, even though it is surgically efficacious. There is limited documentation of its cost-effectiveness in the most affected settings. We therefore sought to assess the cost-effectiveness of surgical intervention for obstetric fistula in Uganda so as to provide appropriate data for policy-makers to prioritize fistula repair and reduce women's suffering in similarly burdened countries. We built a decision-analytic model from the perspective of Uganda's National Health System to estimate the cost-effectiveness of vesico-vaginal and recto-vaginal fistula surgery vs a competing strategy of no surgery for Ugandan women with fistula. Long-term disability outcomes were assessed based on a lifetime Markov state-transition cohort and effectiveness of surgery. Surgical costs were estimated by micro-costing local Ugandan health resources. Disability weights associated with vesico-vaginal, recto-vaginal fistula and mortality rates among the general population in Uganda were based on published sources. The cost of providing fistula repair surgery in Uganda was estimated at $378 per procedure. For a hypothetical 20-year-old woman, surgery was estimated to decrease the lifetime disability burden from 8.53 DALYs to 1.51 DALYs, yielding a cost per DALY averted of $54. The results were robust to variations in model inputs in one-way and probabilistic sensitivity analyses. Surgery for obstetric fistula appears highly cost-effective in Uganda. In similar low-income countries, governments and non-governmental organizations need to prioritize training and strengthening surgical capacity to increase access to fistula surgical care, which would be an important step towards achieving universal health coverage.

Chronic Respiratory Symptoms and Lung Abnormalities Among People With a History of Tuberculosis in Uganda: A National Survey.

People with pulmonary tuberculosis are at risk of developing chronic respiratory disorders due to residual lung damage. To date, the scope of the problem in high-burden tuberculosis countries is relatively unknown. Chronic respiratory symptoms (cough and phlegm lasting >2 weeks) and radiological lung abnormalities were compared between adults with and without a history of tuberculosis among the general population of Uganda. Multivariable regression models were used to estimate odds ratios (ORs) with adjustment for age, gender, smoking, education, setting, and region. Random effects models accounted for village clustering effect. Of 45293 invited people from 70 villages, 41154 (90.9%) participated in the survey. A total of 798 had a history of tuberculosis and, among them, 16% had respiratory symptoms and 41% X-ray abnormalities. Adjusted ORs showed strong evidence for individuals with a history of tuberculosis having increased risk of respiratory symptoms (OR, 4.02; 95% confidence interval [CI], 3.25-4.96) and X-ray abnormalities (OR, 17.52; 95% CI, 14.76-20.79), attributing 6% and 24% of the respective population risks. In Uganda, a history of tuberculosis was a strong predictor of respiratory symptoms and lung abnormalities, before older age and smoking. Eliminating tuberculosis disease could reduce the prevalence of chronic respiratory symptoms as much as eliminating smoking.