Rural Communities In Uganda Research Articles

Feasibility and desirability of scaling up Community\u2013based Health Insurance (CBHI) in rural communities in Uganda: lessons from Kisiizi Hospital CBHI scheme

BackgroundCommunity-based Health Insurance (CBHI) schemes have been implemented world over as initial steps for national health insurance schemes. The CBHI concept developed out of a need for financial protection against catastrophic health expenditures to the poor after failure of other health financing mechanisms. CBHI schemes reduce out-of-pocket payments, and improve access to healthcare services in addition to raising additional revenue for the health sector. Kisiizi Hospital CBHI scheme which was incepted in 1996, has 41,500 registered members, organised in 210 community associations known as ‘Bataka’ or ‘Engozi’ societies. Members pay annual premiums and a co-payment fee before service utilisation. This study aimed at exploring the feasibility and desirability of scaling up CBHI in Rubabo County, with specific objectives of: exploring community perceptions and determining acceptability of CBHI, identifying barriers, enablers to scaling up CBHI and documenting lessons regarding CBHI expansion in a rural community.MethodsExplorative study using qualitative methods of Key informant interviews and Focus Group Discussions (FGDs). Seventeen key informant interviews, three focus group discussions for scheme members and three for non-scheme members were conducted using a topic guide. Data was analysed using thematic approach.ResultsScaling up Kisiizi Hospital CBHI is desirable because: it conforms to the government social protection agenda, society values, offers a comprehensive benefits package, and is a better healthcare financing alternative for many households. Scaling up Kisiizi Hospital CBHI is largely feasible because of a strong network of community associations, trusted quality healthcare services at Kisiizi Hospital, affordable insurance fees, trusted leadership and management systems. Scheme expansion faces some obstacles that include: long distances and high transport costs to Kisiizi Hospital, low levels of knowledge about health insurance, overlapping financial priorities at household level and inability of some households to pay premiums.ConclusionsCBHI implementation requires the following considerations: conformity with society values and government priorities, a comprehensive benefits package, trusted quality of healthcare services, affordable fees, trusted leadership and management systems.

High Prevalence of Antibiotic Resistant Escherichia coli Serotype O157: H7 among Pastoral Communities in Rural Uganda

Background: Non-prescribed use of antimicrobials in Agriculture incurs a transfer risk of resistant pathogens to humans, complicating treatment. The aim of this study was to determine the potential of Zoonotic E. coli to serve as drivers of antimicrobial resistance (AMR) among animals and humans in pastoralist communities in Kasese district, so as to protect the community.
 Materials and Methods: A laboratory based cross-sectional study was done using archived E. coli isolates previously obtained from humans in pastoralist communities of Kasese district, Uganda. Recovery of the isolates was done by conventional culture, and Identification by biochemical methods, serotyping and PCR. Kirby Bauer disc diffusion method was adopted for AMR profiling. Isolates were screened for resistance mechanisms including Extended Spectrum β-lactamase (ESBL), Carbapenemases and AmpC production using disc diffusion based methods.
 Results: The prevalence of Enterohemorrhagic E. coli (EHEC) was 16% (28/180). These EHEC isolates belonged to phylogroups; B1 (94%, 26/28), B2 (3%, 1/28) and A (3%, 1/28). All the 28 EHEC isolates possessed the virulence gene stx1, 26 of the 28 EHEC isolates contained the virulence gene stx2e, but none of the 28 possessed the virulence gene stx2. Highest resistance was seen to Cotrimoxazole (89%, 25/28), Tetracycline (71%, 20/28), Ampicillin (65%, 18/28) and Nitrofurantoin (28%, 8/28), these are the most commonly used antimicrobials in the agricultural sector in Uganda. Minimal resistance was observed to the antimicrobials that are commonly used in human medicine especially β-lactams, β-lactam+inhibitors and Carbapenems. Of the 28 zoonotic E. coli isolates, 17%, (5/28) were ESBL positive and among these 1 (3%, 1/28) was a Carbapenemase producer.
 Conclusion: There is a high prevalence of highly pathogenic, drug resistant E. coli O157:H7 among humans in pastoralist communities in Uganda. We suspect that these were acquired from animals because they mostly contained vero toxin gene vt2e which is animal specific, predominantly swine. Also majority of these EHEC isolates belonged to phylo-group B1 which has been documented to inhabit domestic animals. We recommend future studies to investigate relatedness of drug resistant isolates from humans and animals to ascertain the zoonotic spread of resistant enterohemorrhagic E. coli in pastoralist communities.

Malnutrition amongst HIV adult patients in selected hospitals of Bushenyi district in southwestern Uganda.

Malnutrition is an important clinical outcome amongst HIV patients in developing countries and in Uganda, there is scarcity of information on its prevalence and risk factors amongst HIV adult patients. A cross-sectional study amongst 253 HIV patients in Bushenyi district assessed their nutritional status using the body mass index (BMI) and mid-upper arm circumference (MUAC), and a questionnaire was used to identify major risk factors. The mean age of the study participants was 38.74 ± 0.80 yrs, while females and males were 52.2% and 47.8% respectively. Prevalence of malnutrition was 10.28% (95% CI: 6.82 - 14.69) in the study. Major socio-economic factors associated with malnutrition were being female, unemployed, dependent and with many family members. Patients with opportunistic infections, low adherence to HAART, and stage of HIV/AIDS had a higher risk of malnutrition. In rural communities, a majority of malnourished patients are elderly and these were identified as priority groups for HIV outreach campaigns. The current policy of prioritizing children and women is outdated due to changing disease dynamics, thus showing a need to revise extension service provision in rural communities. Malnutrition is a threat in HIV adult patients in rural communities of Uganda.

SMART2D-development and contextualization of community strategies to support self-management in prevention and control of type 2 diabetes in Uganda, South Africa, and Sweden.

Type 2 diabetes (T2D) and its complications are increasing rapidly in low- and middle-income countries, as well as among socioeconomically disadvantaged populations in high-income countries. Support for healthy lifestyle and self-management is paramount but not well implemented in health systems, and there is need for knowledge on how to design and implement interventions that are contextualized and patient centered and address special needs of disadvantaged population groups. The SMART2D project implements and evaluates a lifestyle and self-management intervention for participants recently diagnosed with or being at increased risk for T2D in rural communities in Uganda, an urban township in South Africa, and socioeconomically disadvantaged urban communities in Sweden. Our aim was to develop an intervention with shared key functions and a good fit with the local context, needs, and resources. The intervention program design was conducted in three steps facilitated by a coordinating team: (a) situational analysis based on the SMART2D Self-Management Framework and definition of intervention objectives and core strategies; (b) designing generic tools for the strategies; and (c) contextual translation of the generic tools and their delivery. This article focuses on community strategies to strengthen support from the social and physical environment and to link health care and community support. Situational analyses showed that objectives and key functions addressing mediators from the SMART2D framework could be shared. Generic tools ensured retaining of functions, while content and delivery were highly contextualized. Phased, collaborative approach and theoretical framework ensured that key functions were not lost in contextualization, also allowing for cross-comparison despite flexibility with other aspects of the intervention between the sites. The trial registration number of this study is ISRCTN11913581.

Hypertension testing and treatment in Uganda and Kenya through the SEARCH study: An implementation fidelity and outcome evaluation

BackgroundHypertension (HTN) is the single leading risk factor for human mortality worldwide, and more prevalent in sub-Saharan Africa than any other region [1]–although resources for HTN screening, treatment, and control are few. Most regional pilot studies to leverage HIV programs for HTN control have achieved blood pressure control in half of participants or fewer [2,3,4]. But this control gap may be due to inconsistent delivery of services, rather than ineffective underlying interventions.MethodsWe sought to evaluate the consistency of HTN program delivery within the SEARCH study (NCT01864603) among 95,000 adults in 32 rural communities in Uganda and Kenya from 2013–2016. To achieve this objective, we designed and performed a fidelity evaluation of the step-by-step process (cascade) of HTN care within SEARCH, calculating rates of HTN screening, linkage to care, and follow-up care. We evaluated SEARCH’s assessment of each participant’s HTN status against measured blood pressure and HTN history.FindingsSEARCH completed blood pressure screens on 91% of participants. SEARCH HTN screening was 91% sensitive and over 99% specific for HTN relative to measured blood pressure and patient history. 92% of participants screened HTN+ received clinic appointments, and 42% of persons with HTN linked to subsequent care. At follow-up, 82% of SEARCH clinic participants received blood pressure checks; 75% received medication appropriate for their blood pressure; 66% remained in care; and 46% had normal blood pressure at their most recent visit.ConclusionThe SEARCH study’s consistency in delivering screening and treatment services for HTN was generally high, but SEARCH could improve effectiveness in linking patients to care and achieving HTN control. Its model for implementing population-scale HTN testing and care through an existing HIV test-and-treat program–and protocol for evaluating the intervention’s stepwise fidelity and care outcomes–may be adapted, strengthened, and scaled up for use across multiple resource-limited settings.

Immigration, Ethnic Diversity and Public Goods Provisioning in Local Communities

A significant body of literature suggests that immigration undermines voluntary contributions to public goods because it leads to ethnic diversity, which in turn erodes social trust. This article posits that the effects of immigration and ethnic diversity on public good provisioning are dissimilar and, that the effect of immigration swamps the effect of ethnic diversity. The article also highlights a need to emphasize the moderating influence of transaction costs when analyzing provisioning problems associated with immigration and ethnic diversity. Focusing on a dozen communities in rural Uganda, and using a mixed-method research design, local attitudes towards efforts at contributing to toilet construction and participating in litter cleanup programs are studied. The findings from data on 293 randomly selected heads of households suggest that socio-political impediments to collective action for public goods provisioning have less to do with the stock of demographic diversity than the flow rate of demographic change. The same findings suggest a more micro-level explanation that transcends the erosive effects of immigration and ethnic diversity to emphasize the moderating influence of transaction costs.

Registration of ‘NAROSORG2’ Sorghum Variety with Desirable Farmer Attributes for Uganda

Sorghum [<i>Sorghum bicolor</i> (L.) Moench] is the major cereal in Uganda that has recently evolved from being a food crop to a cash crop. However, low farm yields of less than 500 kg ha^-1 have been recorded due to both abiotic and biotic stresses. Consequently, NaSARRI developed NAROSORG2, released in 2017, that can withstand some of the abiotic and biotic stresses. NAROSORG2 is a derived red seeded local landrace selection (IS8193) from East Africa, advanced by the International Crops Research Institute for the Semi-Arid Tropics (ICRISAT) through repeated bulk selections for tolerance against abiotic and biotic stresses. The agronomic evaluation was carried out in Uganda for the first and second rainy seasons of 2017 and the findings indicated that NAROSORG2, out-performed the check commercial variety, SESO3 with mean grain yield of 2740 kg ha^-1 across the entire environment. It also recorded early days to 50% flowering of 65.23 days (early maturity variety) like the commercial check variety, SESO3 with a medium height of 165.35 cm. NAROSORG2 has superior agronomic traits of stay-green trait, resistant to bird damage due to high levels of tannins, drought, midge, and Striga tolerant, good for food, and local brew. Therefore, it will supplement other released varieties in contributing to food security and poverty alleviation among the rural communities in Uganda.

Prevalence and Treatment Needs for Early Childhood Caries Among 3-5-Year-Old Children From a Rural Community in Uganda.

Introduction: Early Childhood caries (ECC) is the term used to describe dental caries in children aged 71 months and below. ECC causes a lot of pain and discomfort in the affected children and is expensive to treat. There is limited data on the prevalence of ECC in preschool children resident in the rural Uganda.Aim: To determine the prevalence and treatment needs for ECC among 3–5-year-old nursery school children in a rural community in Rukungiri District, Uganda.Study Design: This was a descriptive cross-sectional study in which 432 nursery school children aged 3–5 years from rural Nyakagyeme sub-county in Ugandan, participated. Informed consent for participation in the study by the children was obtained from their parents/guardians prior to the commencement of the study. The examination of the participants was done under field conditions, with the child lying his or her back of the neck on the PI's lap, with both of them seated on a bench and using natural light augmented with a headlamp to examine the oral cavity. The findings of the examination were recorded on individualized modified WHO Oral Health Assessment Forms for children.Data Analysis: The data gathered were analyzed using Windows SPSS Version 23.0 computer programme, and descriptive results for the variables obtained and Mann Whitney and Kruskal–Wallis tests used to compare and relate the variables. The P<0.05 was considered statistically significant with the Confidence interval set at 95%. The findings were presented in Tables and Figures.Results: A total of 230 (53.2%) male and 202 (46.6%) female participants, with 118 (27.3%), 145 (33.6%), 169 (39.1%) aged 3, 4, and 5 years old respectively, participated in the study. The overall prevalence of dental caries among the participants was 48.6%, with 11.6%, 18.5% and 18.5% recorded for the 3-, 4-, and 5-year old children, respectively. The male participants had a higher prevalence (26.1%) than the female counterparts (22.5%). The mean “dmft” for the participants was 2.04 (SD = 3.01) with the decay component (dt) having the highest value (M = 1.97, SD = 2.89), and contributing to 88.6% of the dental caries experience. The mean “dmft” was 1.79, 2.37 and 1.91 for the 3-, 4-, and 5-year old children, respectively, and the difference in the mean “dmft” among the age groups was not statistically significant.Conclusion: The prevalence of ECC of 48.6% was moderate in this study population. The high level of unmet treatment need as exemplified by the high dental caries experience, was a cause for concern as this forms a risk factor for caries in the permanent dentition.

Utilization of safe male circumcision among adult men in a fishing community in rural Uganda.

In Uganda, most-at-riskpopulations(MARPs) such as fishing communities remain vulnerable to preventable HIV acquisition. Safe Male Circumcision (SMC) has been incorporated into Uganda's HIV prevention strategies. This study aimed at determining SMC utilization and associated factors among adult men in a rural fishing community in Uganda. A cross-sectional study was conducted in a rural fishing village in central Uganda. Stratified random sampling of 369 fishermen aged 18-54 yearswas used according to their occupational category; fish monger, boat crew and general merchandise. The dependent variable wasutilization of SMC.A forward fitting multivariable logistic regression model was fitted with variables significant at p≤0.05 controlling for confounding and effect modification. Respondents'mean(SD) age was 30.0(9.3) years. Only8.4%hadSMC and among non-circumcised men, 84.9% had adequate knowledge of SMC benefits while 79.3% did not know were SMC services were offered. Peer support(AOR0.17;95%-CI0.05-0.60) and perceived procedural safety (AOR6.8;95%CI2.16-21.17) were independently associated with SMC utilization. In this rural fishing community, SMC utilization was low. These findings underscore the need to inform HIV preventionstrategies inthecontextof peer support and perceptionsheld by rural dwelling men.

Effects and acceptability of implementing improved cookstoves and heaters to reduce household air pollution: a FRESH AIR study

The objective was to evaluate the effectiveness and acceptability of locally tailored implementation of improved cookstoves/heaters in low- and middle-income countries. This interventional implementation study among 649 adults and children living in rural communities in Uganda, Vietnam and Kyrgyzstan, was performed after situational analyses and awareness programmes. Outcomes included household air pollution (PM2.5 and CO), self-reported respiratory symptoms (with CCQ and MRC-breathlessness scale), chest infections, school absence and intervention acceptability. Measurements were conducted at baseline, 2 and 6–12 months after implementing improved cookstoves/heaters. Mean PM2.5 values decrease by 31% (to 95.1 µg/m3) in Uganda (95%CI 71.5–126.6), by 32% (to 31.1 µg/m3) in Vietnam (95%CI 24.5–39.5) and by 65% (to 32.4 µg/m3) in Kyrgyzstan (95%CI 25.7–40.8), but all remain above the WHO guidelines. CO-levels remain below the WHO guidelines. After intervention, symptoms and infections diminish significantly in Uganda and Kyrgyzstan, and to a smaller extent in Vietnam. Quantitative assessment indicates high acceptance of the new cookstoves/heaters. In conclusion, locally tailored implementation of improved cookstoves/heaters is acceptable and has considerable effects on respiratory symptoms and indoor pollution, yet mean PM2.5 levels remain above WHO recommendations.

HIV Testing and Treatment with the Use of a Community Health Approach in Rural Africa

BackgroundUniversal antiretroviral therapy (ART) with annual population testing and a multidisease, patient-centered strategy could reduce new human immunodeficiency virus (HIV) infections and improve community health.MethodsWe randomly assigned 32 rural communities in Uganda and Kenya to baseline HIV and multidisease testing and national guideline–restricted ART (control group) or to baseline testing plus annual testing, eligibility for universal ART, and patient-centered care (intervention group). The primary end point was the cumulative incidence of HIV infection at 3 years. Secondary end points included viral suppression, death, tuberculosis, hypertension control, and the change in the annual incidence of HIV infection (which was evaluated in the intervention group only).ResultsA total of 150,395 persons were included in the analyses. Population-level viral suppression among 15,399 HIV-infected persons was 42% at baseline and was higher in the intervention group than in the control group at 3 years (79% vs. 68%; relative prevalence, 1.15; 95% confidence interval [CI], 1.11 to 1.20). The annual incidence of HIV infection in the intervention group decreased by 32% over 3 years (from 0.43 to 0.31 cases per 100 person-years; relative rate, 0.68; 95% CI, 0.56 to 0.84). However, the 3-year cumulative incidence (704 incident HIV infections) did not differ significantly between the intervention group and the control group (0.77% and 0.81%, respectively; relative risk, 0.95; 95% CI, 0.77 to 1.17). Among HIV-infected persons, the risk of death by year 3 was 3% in the intervention group and 4% in the control group (0.99 vs. 1.29 deaths per 100 person-years; relative risk, 0.77; 95% CI, 0.64 to 0.93). The risk of HIV-associated tuberculosis or death by year 3 among HIV-infected persons was 4% in the intervention group and 5% in the control group (1.19 vs. 1.50 events per 100 person-years; relative risk, 0.79; 95% CI, 0.67 to 0.94). At 3 years, 47% of adults with hypertension in the intervention group and 37% in the control group had hypertension control (relative prevalence, 1.26; 95% CI, 1.15 to 1.39).ConclusionsUniversal HIV treatment did not result in a significantly lower incidence of HIV infection than standard care, probably owing to the availability of comprehensive baseline HIV testing and the rapid expansion of ART eligibility in the control group. (Funded by the National Institutes of Health and others; SEARCH ClinicalTrials.gov number, NCT01864603.)

Predictors of isoniazid preventive therapy completion among HIV-infected patients receiving differentiated and non-differentiated HIV care in rural Uganda

ABSTRACT Rates of Isoniazid Preventive Therapy (IPT) completion remain low in programmatic settings in sub-Saharan Africa. Differentiated HIV care models may improve IPT completion by addressing joint barriers to IPT and HIV treatment. However, the impact of differentiated care on IPT completion remains unknown. In a cross-sectional study of people with HIV on antiretroviral therapy in 5 communities in rural Uganda, we compared IPT completion between patients receiving HIV care via a differentiated care model versus a standard HIV care model and assessed multi-level predictors of IPT completion. A total of 103/144 (72%) patients received differentiated care and 85/161 (53%) received standard care completed IPT (p < 0.01). Adjusting for age, gender and community, patients receiving differentiated care had higher odds of completing IPT (aOR: 2.6, 95% CI: 1.5–4.5, p < 0.01). Predictors of IPT completion varied by the care model, and differentiated care modified the positive association between treatment completion and the belief in the efficacy of IPT and the negative association with side-effects. Patients receiving a multi-component differentiated care model had a higher odds of IPT completion than standard care, and the model’s impact on health beliefs, social support, and perceived side effects to IPT may underlie this positive association.

Hypertension control in integrated HIV and chronic disease clinics in Uganda in the SEARCH study

BackgroundThere is an increasing burden of hypertension (HTN) across sub-Saharan Africa where HIV prevalence is the highest in the world, but current care models are inadequate to address the dual epidemics. HIV treatment infrastructure could be leveraged for the care of other chronic diseases, including HTN. However, little data exist on the effectiveness of integrated HIV and chronic disease care delivery systems on blood pressure control over time.MethodsPopulation screening for HIV and HTN, among other diseases, was conducted in ten communities in rural Uganda as part of the SEARCH study (NCT01864603). Individuals with either HIV, HTN, or both were referred to an integrated chronic disease clinic. Based on Uganda treatment guidelines, follow-up visits were scheduled every 4 weeks when blood pressure was uncontrolled, and either every 3 months, or in the case of drug stock-outs more frequently, when blood pressure was controlled. We describe demographic and clinical variables among all patients and used multilevel mixed-effects logistic regression to evaluate predictors of HTN control.ResultsFollowing population screening (2013–2014) of 34,704 adults age ≥ 18 years, 4554 individuals with HTN alone or both HIV and HTN were referred to an integrated chronic disease clinic. Within 1 year 2038 participants with HTN linked to care and contributed 15,653 follow-up visits over 3 years. HTN was controlled at 15% of baseline visits and at 46% (95% CI: 44–48%) of post-baseline follow-up visits. Scheduled visit interval more frequent than clinical indication among patients with controlled HTN was associated with lower HTN control at the subsequent visit (aOR = 0.89; 95% CI 0.79–0.99). Hypertension control at follow-up visits was higher among HIV-infected patients than uninfected patients to have controlled blood pressure at follow-up visits (48% vs 46%; aOR 1.28; 95% CI 0.95–1.71).ConclusionsImproved HTN control was achieved in an integrated HIV and chronic care model. Similar to HIV care, visit frequency determined by drug supply chain rather than clinical indication is associated with worse HTN control.Trial registrationThe SEARCH Trial was prospectively registered with ClinicalTrials.gov: NCT01864603.

Distance to clinic is a barrier to PrEP uptake and visit attendance in a community in rural Uganda.

IntroductionGeographic and transportation barriers are associated with poorer HIV‐related health outcomes in sub‐Saharan Africa, but data on the impact of these barriers on prevention interventions are limited. We estimated the association between distance to clinic and other transportation‐related barriers on pre‐exposure prophylaxis (PrEP) uptake and initial clinic visit attendance in a rural community in southwestern Uganda enrolled in the ongoing SEARCH study (NCT01864603).MethodsCommunity‐wide HIV testing was conducted and offered to adult (≥15 years) participants in Ruhoko. Participants were eligible for PrEP based on an empiric risk score, having an HIV‐discordant partner, or self‐referral at either the community health campaign or during home‐based testing from March to April 2017. We collected data from PrEP‐eligible households on GPS‐measured distance to clinic, walking time to clinic and road difficulty. A sample of participants was also asked to identify their primary barriers to PrEP use with a semi‐quantitative questionnaire. We used multivariable logistic regression to evaluate the association between transportation barriers and (1) PrEP uptake among PrEP‐eligible individuals and (2) four‐week clinic visit attendance among PrEP initiators.ResultsOf the 701 PrEP‐eligible participants, 272 (39%) started PrEP within four weeks; of these, 45 (17%) were retained at four weeks. Participants with a distance to clinic of ≥2 km were less likely to start PrEP (aOR 0.34; 95% CI 0.15 to 0.79, p = 0.012) and less likely to be retained on PrEP once initiated (aOR 0.29; 95% CI 0.10 to 0.84; p = 0.024). Participants who were deemed eligible during home‐based testing and did not have the option of same‐day PrEP start were also substantially less likely to initiate PrEP (aOR 0.16, 95% CI 0.07 to 0.37, p < 0.001). Of participants asked to name barriers to PrEP use (N = 98), the most frequently cited were “needing to take PrEP every day” (N = 18) and “low/no risk of getting HIV” (N = 18). Transportation‐related barriers, including “clinic is too far away” (N = 6) and “travel away from home” (N = 4) were also reported.ConclusionsDistance to clinic is a significant predictor of PrEP uptake and four‐week follow‐up visit attendance in a community in rural Uganda. Interventions that address geographic and transportation barriers may improve PrEP uptake and retention in sub‐Saharan Africa.

Medicinal plant species used in the treatment of skin diseases in Katabi Subcounty, Wakiso District, Uganda

Background : The use of medicinal plants in primary healthcare is central among rural communities in Uganda given the expensive and often inaccessible conventional healthcare. Skin diseases pose a serious health risk given the challenge of HIV-AIDS whose opportunist infections manifest as skin complications.The study identified and documented plant species used to manage skin infections, plant parts used, methods of preparation and administration of herbal remedies. Methods: An ethnobotanical survey of plant species used to treat skin diseases was conducted in Katabi Sub-County, Wakiso District in Uganda using semi structured interviews. Twenty villages were surveyed with at least three respondents from each village interviewed. A questionnaire, checklist, and personal observation were the research instruments used. Descriptive statistics were used to present the data. Results: A total of 52 plants belonging to 33 families were documented. The highest proportion of species (25%) was used against fungal infections. Other proportions of plants against their respective diseases were; 24%, 20%, 16% and 16% for allergies, wounds, skin rash and warts respectively. The commonly used species were Iboza multiflora , Psorospermum febrifugum , Albizia coriaria , Hoslundia opposita , Justicia betonica , and Euphorbia tirucalli. Herbs (55%) were the main growth habit followed by trees (25%), shrubs (17%) and vines (and grasses) (3%). Leaves (54%) and flowers (11%) were the most commonly used plant parts while topical administration to affected parts was the major method of administration. Conclusion: Plant species used against skin diseases in Katabi Sub-County provides basic data for further studies focused on their pharmacological activity and conservation.

Validation of heart failure quality of life tool and usage to predict all-cause mortality in acute heart failure in Uganda: the Mbarara heart failure registry (MAHFER)

BackgroundThe health-related quality of life (HRQoL) is an important treatment goal that could serve as low-cost prognostication tool in resource poor settings.We sought to validate the Kansas City Cardiomyopathy Questionnaire (KCCQ) and evaluate its use as a predictor of 3 months all-cause mortality among heart failure participants in rural Uganda.MethodsThe Mbarara Heart Failure Registry Cohort study observes heart failure patients during hospital stay and in the community in rural Uganda. Participants completed health failure evaluations and HRQoL questionnaires at enrollment, 1 and 3 months of follow-up. We used Cronbach’s alpha coefficients to define internal consistency, intraclass correlation coefficients as a reliability coefficient, and Cox proportional hazard models to predict the risk of 3 months all-cause mortality.ResultsAmong the 195 participants who completed HRQoL questionnaires, the mean age was 52 (standard deviation (SD) 21.4) years, 68% were women and 29% reported history of hypertension. The KCCQ had excellent internal consistency (87% Cronbach alpha) but poor reliability. Independent predictors of all-cause mortality within 3 months included: worse overall KCCQ score (Adjusted Hazard ratio (AHR) 2.9, 95% confidence interval (CI) 1.1, 8.1), highest asset ownership (AHR 3.6, 95% CI 1.2, 10.8), alcoholic drinks per sitting (AHR per 1 drink 1.4, 95% CI 1.0, 1.9), New York Heart Association (NYHA) functional class IV heart failure (AHR 2.6, 95% CI 1.3, 5.4), estimated glomerular filtration rate (eGFR) 30 to 59 ml/min/1.73 m2 (AHR 3.4, 95% CI 1.1, 10.8), and eGFR less than 15 ml/min/1.73 m2 (AHR 2.7, 95% CI 1.0, 7.1), each 1 pg/mL increase in Brain Natriuretic Peptide (BNP) (AHR, 1.0, 95% CI 1.0, 1.0), and each 1 ng/mL increase in Creatine-Kinase MB isomer (CKMB) (AHR 1.0, 95% CI 1.0, 1.1).ConclusionThe KCCQ showed excellent internal consistency. Worse overall KCCQ score, highest asset ownership, increasing alcoholic drink per sitting, NYHA class IV, decreased estimated glomerular filtration rate, BNP, and CKMB predicted all-cause mortality at 3 months. The KCCQ could be an additional low-cost tool to aid in the prognostication of acute heart failure patients.

Cattle-associated risk factors for human tuberculosis in rural livestock-keeping communities, Uganda.

Tuberculosis (TB) is a leading infectious cause of human death worldwide. In cattle, TB infection results in productivity losses, trade barriers and zoonotic transmission via milk, meat or direct contact. We conducted a cross-sectional study in rural communities in Uganda between 2014 and 2016 to evaluate the association between tuberculosis skin test (TST) positivity in humans and cattle-associated risk factors: household herd positivity and raw milk consumption. Human and cattle TSTs were performed in communities followed by a survey of household practices. TST data were available on 493 humans, 184 (37.3%) with positive results, and 1,441 cattle, 50 (3.5%) with positive results. We fit separate log binomial generalized estimating equation models for the herd positivity-human TST positivity association, stratified on sex; and for the raw milk consumption-human TST positivity association, stratified on frequency of milk consumption. Having at least one TST-positive bovid in the household's herd was significantly associated with lower risk of TB among men (prevalence ratio [PR] 0.66, 95% CI 0.49, 0.87) but was not significantly associated with TB among women (PR 1.21, 95% CI 0.76, 1.95). This apparent protective effect was contrary to our a priori hypothesis of higher exposure effect among men, the primary caretakers of cattle. This finding may be the result of residual confounding by socioeconomic status; wealthier individuals may be less likely to be TB positive, but more likely to have TST-positive herds by virtue of larger herd sizes, ability to purchase new and possibly infected stock, and propensity to keep more TB-susceptible European breeds. For raw milk consumption, effect estimates were close to one and not statistically significant. Thus, in settings where bovine TB prevalence is low, such as Uganda, cattle-associated zoonotic transmission may be rare, and cattle-associated risk factors may not be important drivers of human TB burden.

Exploring the prevalence of high-risk obstetric conditions diagnosed by point-of-care ultrasound evaluation in a rural Ugandan population: a cohort study

Objective: The aim of this study was to determine the prevalence of high-risk obstetric conditions identified by point-of-care ultrasound in a rural Ugandan community and compare them with known rates in high-income settings. Methods: Pregnant women in a rural Ugandan clinic were offered a screening obstetric ultrasound at a late second or third trimester antenatal visit (Clearvue 350). Appropriate follow-up was determined by a preset algorithm. Placental abnormalities, multiple gestations, and fetal malpresentation were recorded. Descriptive statistics were used for analysis. Results: Fetal malpresentation in the third trimester was found in 15% [confidence interval (CI), 11.7–18.6] of pregnancies. Rates of multiple gestations and placental location abnormalities were 4% (CI, 2.7–5.2) and 1.7% (CI, 0.8–2.5), respectively. Overall, prevalence of abnormal placentation was comparable to published rates, although persistent fetal malpresentation was higher than in the United States. The rate of multiple gestations is on par with United States data despite lack of access to artificial reproductive technology. Conclusions: Given that placental abnormalities, multiple gestations, and fetal malpresentation in a rural Ugandan population are at least as common as in high-income countries, and emergency obstetric care is more difficult to access in Uganda, the contribution of these conditions to maternal mortality is likely higher in rural Uganda. Ultrasound can be used to identify and refer patients to higher-level facilities for safe delivery.

How does water information flow? Intersectionality in water information networks in a rural Ugandan community

ABSTRACTThis article presents evidence of a Ugandan community’s information network related to water services and argues that an intersectional perspective is key to understanding information exclusion processes. Using questionnaire data and social network analysis, the article compares access to water information channels by gender and education level. While men primarily share information with other men, women mainly exchange water information along educational lines. Less-educated women are least likely to receive information from other gender-education groups. Women are also underrepresented in the network of local government officials and consequently lack bridging ties, remaining more dependent on informal information channels.

Relevance of informal institutions for achieving sustainable crop intensification in Uganda

Informal institutions play an important role in the socio-cultural lives of rural communities in Uganda. However, little attention is given in research and development to understanding the influence of informal institutions in efforts to achieve Sustainable Crop Intensification (SCI). Such evidence is, however, pertinent to addressing low crop productivity by designing and implementing interventions that take into account the socio-cultural and institutional barriers and opportunities for SCI. This paper analyzes the influence of informal institutions on farmers’ access to land resources, financial resources, and farm inputs. The analysis is based on qualitative and quantitative data collected between January and May 2015 using 61 in-depth interviews, field surveys with 120 farmers and 18 gender-segregated focus group discussions in Eastern and Southwestern Uganda. Results indicate that informal institutions play a central role in enhancing farmers’ investment in SCI interventions by facilitating access to land through inheritance, land rentals, and labor sharing arrangements, although they are biased against non-clan members and female members of the communities. Informal institutions also enable access to financial resources by farmers at lower transaction cost compared to formal financial institutions. Yet, the informal institutions face challenges related to poor rule enforcement and limited financial reserves. The contribution of informal institutions in improving farmers’ access to (i) external farm inputs, (ii) serving as forums for knowledge sharing and (iii) regulating quality of farm inputs is minimal. Findings imply that development interventions could benefit from using informal institutions as entry points for investment in SCI and building on institutions’ strengths in influencing access to land and financial resources. Policies and programs that promote the SCI approach need to recognize the role of informal institutions for increased implementation and impact.