Southwest Uganda Research Articles

Travel and the emergence of high-level drug resistance in Plasmodium falciparum in southwest Uganda: results from a population-based study

BackgroundThe I164L mutation on the dhfr gene confers high level resistance to sulfadoxine–pyrimethamine (SP) but it is rare in Africa except in a cluster of reports where prevalence >10% in highland areas of southwest Uganda and eastern Rwanda. The occurrence of the dhfr I164L mutation was investigated in community surveys in this area and examined the relationship to migration.MethodsA cross-sectional prevalence survey was undertaken in among villages within the catchment areas of two health facilities in a highland site (Kabale) and a highland fringe site (Rukungiri) in 2007. Sociodemographic details, including recent migration, were collected for each person included in the study. A total of 206 Plasmodium falciparum positive subjects were detected by rapid diagnostic test; 203 in Rukungiri and 3 in Kabale. Bloodspot samples were taken and were screened for dhfr I164L.ResultsSequence analysis confirmed the presence of the I164L mutations in twelve P. falciparum positive samples giving an estimated prevalence of 8.6% in Rukungiri. Of the three parasite positive samples in Kabale, none had I164L mutations. Among the twelve I164L positives three were male, ages ranged from 5 to 90 years of age. None of those with the I164L mutation had travelled in the 8 weeks prior to the survey, although three were from households from which at least one household member had travelled during that period. Haplotypes were determined in non-mixed infections and showed the dhfr I164L mutation occurs in both as a N51I + S108N + I164L haplotype (n = 2) and N51I + C59R + S108N + I164L haplotype (n = 5). Genotyping of flanking microsatellite markers showed that the I164L occurred independently on the triple mutant (N51I, C59R + S108N) and double mutant (N51I + S108N) background.ConclusionsThere is sustained local transmission of parasites with the dhfr I164L mutation in Rukungiri and no evidence to indicate its occurrence is associated with recent travel to highly resistant neighbouring areas. The emergence of a regional cluster of I164L in SW Uganda and Rwanda indicates that transmission of I164L is facilitated by strong drug pressure in low transmission areas potentially catalysed in those areas by travel and the importation of parasites from relatively higher transmission settings.

Homegardens and the future of food and nutrition security in southwest Uganda

Governments around the world seek to create programs that will support sustainable agriculture and achieve food security, yet they are faced with uncertainty, system complexity and data scarcity when making such choices. We propose decision modeling as an innovative approach to help meet these challenges and offer a case study to show the effectiveness of the tool. We use decision analysis tools to model the possible nutrition-related outcomes of the Ugandan government's long term agricultural development plan termed ‘Vision 2040’. The analysis indicates potential shifts in household nutritional contributions through the comparison of the current small-scale diverse systems and the envisioned industrial agricultural systems that may replace them. A Monte Carlo simulation revealed that Vision 2040 plans outperform homegardens in terms of energy and some macronutrients, yet homegardens are likely to be better at producing key vitamins and micronutrients, such as Vitamin A. Value of information calculations applied to Monte Carlo outputs further revealed that gathering more data on the annual yields and nutrient contents of staples, pulses, vegetables, and fruits could improve certainty about the nutrition contribution of both scenarios. We conclude that the development of Uganda's agricultural sector should consider the role that agrobiodiversity in the current small-scale agricultural systems plays in national food and nutrition security. Any changes according to Vision 2040 should also include farmers' voices and current crop management systems as guides for a sustainable food supply in the region. This modeling approach may be a tool for governments to consider agricultural policy implications, especially given the data scarcity and agricultural variability in regions such as East Africa.

Complex agricultural livelihoods and aflatoxin exposure in rural Uganda

Aflatoxins are secondary metabolites produced by Aspergillus flavus and A. parasiticus species of fungi. They are highly toxic and have been designated by the International Agency for Research on Cancer (IARC) as human carcinogens (Class 1: definitely carcinogenic to humans). High levels of exposure can cause acute hepatic necrosis and death while chronic exposure can cause carcinoma of the liver and possibly also growth impairment in children and compromised immunity. Contamination of crops most often occurs during harvest and storage, when damp, warm conditions allow the fungi to proliferate. Possible barriers to effective local interventions to reduce exposure were explored, by examining agricultural livelihoods and patterns of household food consumption within a population cohort in rural south west Uganda. Previous work in this cohort and elsewhere in Uganda showed that aflatoxin exposure was ubiquitous and that there are multiple sources of exposure. Data on agricultural practices were collected through a survey of 200 households; 22 of those were randomly selected for in-depth interviews. While crops such as maize, cassava, beans and groundnuts - all potential sources of aflatoxin - are grown, stored and consumed locally, the sale of home-grown foods, unfavourable climate, pests and diseases and limited labour, all facilitate food scarcities and subsequent insecurities leading to purchase of poorly stored foods which may also contain aflatoxins. Processed foods are easily accessible by many households, from the numerous trading centres established within villages. This paper gives background information on heterogeneity of household diets and seasonal trends in food consumption in rural Uganda and by so doing, identifies potential risk factors for aflatoxin contamination in the study area. Risks of aflatoxin contamination are multifaceted and this complexity makes it challenging to design and implement risk control measures and advocacy strategies. The argument of the paper is that the complexity of agricultural livelihoods and patterns of household food consumption in rural Uganda may mitigate the impact of simple, local interventions to reduce aflatoxin exposure. Therefore, intervention approaches need to take into account this complexity in order to minimize risk factors, especially amongst poor populations in rural areas.

Workplace Stress Induced among Nurses at Mbarara Regional Referral Hospital, South West Uganda

This study aimed at assessing the factors contributing to stress in nurses’ workplace was conducted at Mbarara Regional Referral Hospital, South West Uganda. Random sampling method was used to select 50 nurses out of 180 that were on duty when data was collected. The data was collected using self-structured questionnaire. The results show that 25 (50%), said that their job condition is stressful, 5 (5%) said fair, 10% said they have a very poor job condition. 40% agreed that job promotion is done on merit, 20% of the respondents noted that promotion is done based on performance. 20% agreed that it’s done depending on experience while 8% said it’s done basing on vacancies and 12% were other factors. It was concluded that the working condition at Mbarara Referral Hospital present many stressor to nursing staff which include irregular working hours ,poor remuneration, poor communication and co-ordination by the administration. It was recommended that the hospital administration should regularize the working hours, improve on the salary of workers and also improve the communication channels with the nurses.

Comparison of infant- and young child-feeding practices among HIV-positive mothers and those of unknown HIV status in Buhweju district, Southwest Uganda

Comparison of infant- and young child-feeding practices among HIV-positive mothers and those of unknown HIV status in Buhweju district, Southwest Uganda

Factors Influencing Neonatal Care, Breastfeeding, and Infant Nutrition in Rural South-West Uganda

Factors Influencing Neonatal Care, Breastfeeding, and Infant Nutrition in Rural South-West Uganda

Female respondent acceptance of computer-assisted personal interviewing (CAPI) for maternal, newborn and child health coverage surveys in rural Uganda

IntroductionHigh maternal and child mortality continues in low- and middle-income countries (LMIC). Measurement of maternal, newborn and child health (MNCH) coverage indicators often involves an expensive, complex, and lengthy household data collection process that is especially difficult in less-resourced settings. Computer-assisted personal interviewing (CAPI) has been proposed as a cost-effective and efficient alternative to traditional paper-and-pencil interviewing (PAPI). However, the literature on respondent-level acceptance of CAPI in LMIC has reported mixed outcomes. This is the first study to prospectively examine female respondent acceptance of CAPI and its influencing factors for MNCH data collection in rural Southwest Uganda. MethodsEighteen women aged 15–49 years were randomly selected from 3 rural villages to participate. Each respondent was administered a Women’s Questionnaire with half of the survey questions asked using PAPI techniques and the other half using CAPI. Following this PAPI/CAPI exposure, semi-structured focus group discussions (FGDs) assessed respondent attitudes towards PAPI versus CAPI. FGD data analysis involved an immersion/crystallization method (thematic narrative analysis). ResultsThe sixteen FGD respondents had a median age of 27 (interquartile range: 24.8, 32.3) years old. The majority (62.5%) had only primary level education. Most respondents (68.8%) owned or regularly used a mobile phone or computer. Few respondents (31.3%) had previously seen but not used a tablet computer. Overall, FGDs revealed CAPI acceptance and the factors influencing CAPI acceptability were ‘familiarity’, ‘data confidentiality and security’, ‘data accuracy’, and ‘modernization and development’. DiscussionFemale survey respondents in our rural Southwest Ugandan setting found CAPI to be acceptable. Global health planners and implementers considering CAPI for health coverage survey data collection should accommodate influencing factors during survey planning in order to maximize and facilitate acceptance and support by local stakeholders and community participants. Further research is needed to generate best practices for CAPI implementation and LMIC; higher quality, timely, streamlined and budget-friendly collection of MNCH indicators could help direct and improve programming to save lives of mothers and children.

Community health workers adherence to referral guidelines: evidence from studies introducing RDTs in two malaria transmission settings in Uganda.

BackgroundMany malaria-endemic countries have implemented national community health worker (CHW) programmes to serve remote populations that have poor access to malaria diagnosis and treatment. Despite mounting evidence of CHWs’ ability to adhere to malaria rapid diagnostic tests (RDTs) and treatment guidelines, there is limited evidence whether CHWs adhere to the referral guidelines and refer severely ill children for further management. In southwest Uganda, this study examined whether CHWs referred children according to training guidelines and described factors associated with adherence to the referral guideline.MethodsA secondary analysis was undertaken of data collected during two cluster-randomized trials conducted between January 2010 and July 2011, one in a moderate-to-high malaria transmission setting and the other in a low malaria transmission setting. All CHWs were trained to prescribe artemisinin-based combination therapy (ACT) and recognize symptoms in children that required immediate referral to the nearest health centre. Intervention arm CHWs had additional training on how to conduct an RDT; CHWs in the control arm used a presumptive diagnosis for malaria using clinical signs and symptoms. CHW treatment registers were reviewed to identify children eligible for referral according to training guidelines (temperature of ≥38.5 °C), to assess whether CHWs adhered to the guidelines and referred them. Factors associated with adherence were examined with logistic regression models.ResultsCHWs failed to refer 58.8% of children eligible in the moderate-to-high transmission and 31.2% of children in the low transmission setting. CHWs using RDTs adhered to the referral guidelines more frequently than CHWs not using RDTs (moderate-to-high transmission: 50.1 vs 18.0%, p = 0.003; low transmission: 88.5 vs 44.1%, p < 0.001). In both settings, fewer than 20% of eligible children received pre-referral treatment with rectal artesunate. Children who were prescribed ACT were very unlikely to be referred in both settings (97.7 and 73.3% were not referred in the moderate-to-high and low transmission settings, respectively). In the moderate-to-high transmission setting, day and season of visit were also associated with the likelihood of adherence to the referral guidelines, but not in the low transmission setting.ConclusionsCHW adherence to referral guidelines was poor in both transmission settings. However, training CHWs to use RDT improved correct referral of children with a high fever compared to a presumptive diagnosis using sign and symptoms. As many countries scale up CHW programmes, routine monitoring of reported data should be examined carefully to assess whether CHWs adhere to referral guidelines and take remedial actions where required.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1609-7) contains supplementary material, which is available to authorized users.

How do individuals and groups perceive wetland functioning? Fuzzy cognitive mapping of wetland perceptions in Uganda

Wetlands are critical natural resources around the globe, providing many direct and indirect benefits to local communities. However, wetland degradation and conversion to other land uses are widespread. Sustainable wetland management requires an understanding of stakeholders’ perceptions of the ecosystem and its management. This paper uses fuzzy cognitive mapping to capture individual stakeholder perceptions and group knowledge of wetland ecosystems in order to assess areas of consensus and opposing interests between different stakeholders and to develop future management scenarios. For this purpose, the Rushebeya-Kanyabaha wetland, which is one of the few wetlands in southwest Uganda that is still largely intact, is used as a case study. Our findings reveal differences in perceptions between different resource users. Papyrus harvesters, beekeepers, fishermen, wetland non-users, and hunters associate the largest livelihood benefits with a wetland conservation scenario, while farmers and government officials perceive increased agricultural production in the wetland area to be more livelihood enhancing. This poses a challenge to sustainable wetland management. The scenario results also suggest that centralized top-down laws and rules on wetland use are not sufficient for maintaining the wetland ecosystem. Therefore, there is a need to develop shared understanding through bottom-up approaches to wetland management that are nested within national regulatory frameworks, ideally combined with awareness building and knowledge sharing on the ecological benefits of the wetland.

Family planning in a rural setting in Uganda, the USHAPE initiative.

BackgroundThe total fertility rate in Uganda is 5.9 children per woman, and women admit to having nearly two more children than they actually want. The maternal mortality rate remains stubbornly high. Family planning saves lives. It prevents maternal deaths by delaying motherhood, helping women limit their family size and avoid unwanted pregnancies. It also reduces infant mortality.SettingUSHAPE (Ugandan Sexual Health and Pastoral Education) is an initiative run in conjunction with the Royal College of General Practitioners in south-west Uganda. USHAPE aims to disseminate positive messages about modern contraception in an attempt to dispel fears and misconceptions and address the high rate of unmet need.QuestionThe aim was to determine the rate of unmet need for family planning among women of reproductive age in the population local of Kisiizi hospital and to use the successful USHAPE model to train health workers to address this need.Methods100 patients were screened in the outpatient department to determine the level of unmet need by asking 2 questions. Level 1 training aims enhance every staff member’s knowledge, so that the responsibility for family planning is adopted by the whole institution. Level 2 trains clinicians to become full family planning providers, with the necessary communication, educational and practical skills.ResultsThe screening for unmet need for contraception revealed that 51% have an unmet need, which is higher than the national average of 38%. Sixty-eight members of staff at Kisiizi trained to a basic level and a further 32 staff have been trained to Level 2 higher level.Conclusions/DiscussionThe USHAPE approach has begun to tackle some of the barriers to accessing family planning, but there are further areas which need development. Our cascade model of training, involves training Ugandan USHAPE trainers with the aim of future scale up and long-term development.

Population based haematology reference ranges for old people in rural South-West Uganda.

BackgroundHaematology reference values are needed to interpret haematology results and make clinical decisions, but these have not been established for old people in sub-Saharan Africa. The objective of this study was to establish haematology reference values for people aged 50 years and above in Uganda, to compare the haematology reference values for those aged 65 years and over with those less than 65 years and to compare these haematology reference values with established haematology reference values for old people from high income countries.MethodsA total of 1449 people aged 50 years and above were recruited from the Medical Research Council/Uganda Virus Research Institute general population cohort between January 2012 and January 2013 (response rate 72.3 %). From the blood samples collected, we did haematology, HIV testing and malaria tests. We also obtained stool samples and tested them for hookworm infection. Questionnaire data were obtained through interviews. In the analysis, we excluded those with HIV infection, malaria infection, hookworm infection and those not feeling well at the time of recruitment. Medians and reference ranges for 12 haematology parameters were determined, based on the Clinical Laboratory and Standards institute’s guidelines.ResultsIn total, 903 people aged 50 years and above were included in the analysis with the majority 545 (60.3 %) being female. Men had significant difference in median haemoglobin, haematocrit, erythrocytes counts and white blood cells counts, which were higher than those of women. Women had significant difference in mean platelet counts and neutrophil percentages which were higher than those of men. Comparing those aged 65+ and those aged less than 65 years, the following parameters were significantly lower in those aged above 65 years: haemoglobin, haematocrit, erythrocytes counts, platelets and mean corpuscular volume. Compared to the reference intervals from old people in high income countries, all the haematology parameters from our study population were low.ConclusionThe differences between haematology reference ranges in old people compared to adults and the very old (65+) compared to those between 50 and 65 call for more population based studies using nationwide surveys to be carried out among old people in other study settings in Uganda and the rest of Africa to explore the differences in haematology reference ranges between these different age groups with a view of establishing whether there is need to have separate reference range for these different categories of old people.

Elephant (Loxodonta africana) footprints as habitat for aquatic macroinvertebrate communities in Kibale National Park, south-west Uganda

This is the first study where elephant footprints as habitat for aquatic macroinvertebrate communities were assessed. Preliminary observations during the dry season in Kibale Forest, Uganda, indicated that water-filled footprints constituted the majority of stagnant ponds. Consequently, this study aimed at giving an overview of the diversity and ecology of those habitats and the capacity of elephants as ecosystem engineers. The fauna and abiotic factors (age, size, substrate, organic matter, pH, canopy cover, temperature, conductivity) of 30 water-filled natural elephant footprints were sampled, resulting in the record of 61 morphospecies among 27 families/orders. Species composition was dominated by Hydrophilidae and Dytiscidae and influenced by environmental variables, such as age and organic matter. To study the colonization process, 18 artificial footprints were created within different distances from the water source. After 5 days, 410 specimens were collected, with higher species richness in artificial footprints closer to a natural water source. We conclude that colonization of water-filled footprints is fast, they constitute important habitats with high diversity and variability, and they act as stepping stones for dispersal and add to the ability of elephants as ecosystem engineers. We emphasize the importance of elephants as a key species in ecosystem dynamics and conservation practice.

Do maternal knowledge and attitudes towards childhood immunizations in rural Uganda correlate with complete childhood vaccination?

Improving childhood vaccination coverage and timeliness is a key health policy objective in many developing countries such as Uganda. Of the many factors known to influence uptake of childhood immunizations in under resourced settings, parents' understanding and perception of childhood immunizations has largely been overlooked. The aims of this study were to survey mothers' knowledge and attitudes towards childhood immunizations and then determine if these variables correlate with the timely vaccination coverage of their children. From September to December 2013, we conducted a cross-sectional survey of 1,000 parous women in rural Sheema district in southwest Uganda. The survey collected socio-demographic data and knowledge and attitudes towards childhood immunizations. For the women with at least one child between the age of one month and five years who also had a vaccination card available for the child (N = 302), the vaccination status of this child was assessed. 88% of these children received age-appropriate, on-time immunizations. 93.5% of the women were able to state that childhood immunizations protect children from diseases. The women not able to point this out were significantly more likely to have an under-vaccinated child (PR 1.354: 95% CI 1.018-1.802). When asked why vaccination rates may be low in their community, the two most common responses were fearful of side effects and ignorance/disinterest/laziness (44% each). The factors influencing caregivers' demand for childhood immunizations vary widely between, and also within, developing countries. Research that elucidates local knowledge and attitudes, like this study, allows for decisions and policy pertaining to vaccination programs to be more effective at improving child vaccination rates.

The Imaramagambo Onchocerciasis Focus in Southwestern Uganda: Interruption of Transmission After Disappearance of the Vector Simulium neavei and Its Associated Freshwater Crabs.

It was not until early 1990s that, when the Imaramagambo focus of southwest Uganda was mapped, mass treatment with a single annual dose of ivermectin for onchocerciaisis control commenced. However, comprehensive investigations on its transmission were launched after a nationwide policy for onchocerciasis elimination in 2007. Entomological surveys throughout the focus from 2007 to 2015 have yielded few or no freshwater crabs (Potamonautes aloysiisabaudiae), which serve as the obligate phoretic host of the larvae and pupae of the vector Simulium neavei. No S. neavei flies have been observed or collected since 2007. Skin snips (microscopy) from 294 individuals in 2008 were negative for skin microfilariae, and of the 462 persons analyzed by polymerase chain reaction skin snip poolscreen in 2009, only five (1.08%) persons were indicated as infected with onchocerciasis. All five of the positive persons were at least 40 years old. Serosurvey results showed negative exposure among 3,332 children in 2012 and 3,108 children in 2015. Both were within the upper bound of the 95% confidence interval of the prevalence estimate of 0.06%, which confirmed the elimination of onchocerciasis. Treatment coverage in Imaramagambo was generally poor, and transmission interruption of onchocerciasis could not be attributed solely to annual mass treatment with ivermectin. There was sufficient evidence to believe that the possible disappearance of the S. neavei flies, presumed to have been the main vector, may have hastened the demise of onchocerciasis in this focus.

Abstract #209: Assesment of Functional Status in Diabetic and Hypertensive Patients: Experience from Rural South West Uganda

Abstract #209: Assesment of Functional Status in Diabetic and Hypertensive Patients: Experience from Rural South West Uganda

Application of Serological Tools and Spatial Analysis to Investigate Malaria Transmission Dynamics in Highland Areas of Southwest Uganda.

Serological markers, combined with spatial analysis, offer a comparatively more sensitive means by which to measure and detect foci of malaria transmission in highland areas than traditional malariometric indicators. Plasmodium falciparum parasite prevalence, seroprevalence, and seroconversion rate to P. falciparum merozoite surface protein-119 (MSP-119) were measured in a cross-sectional survey to determine differences in transmission between altitudinal strata. Clusters of P. falciparum parasite prevalence and high antibody responses to MSP-119 were detected and compared. Results show that P. falciparum prevalence and seroprevalence generally decreased with increasing altitude. However, transmission was heterogeneous with hotspots of prevalence and/or seroprevalence detected in both highland and highland fringe altitudes, including a serological hotspot at 2,200 m. Results demonstrate that seroprevalence can be used as an additional tool to identify hotspots of malaria transmission that might be difficult to detect using traditional cross-sectional parasite surveys or through vector studies. Our study findings identify ways in which malaria prevention and control can be more effectively targeted in highland or low transmission areas via serological measures. These tools will become increasingly important for countries with an elimination agenda and/or where malaria transmission is becoming patchy and focal, but receptivity to malaria transmission remains high.

Pathology's Impact on Care and Treatment

![Graphic][1] I write this article on World Cancer Day (February 4), as I reflect on the impact of pathology on care and treatment with respect to cancer. In the U.S., we take it for granted that a patient's cancer care and treatment begins with accurate and timely diagnosis, but what if that is not available, as is the case in many low- and middle-income countries? This issue of Critical Values highlights the experiences of some ASCP members in resource-limited countries. In an article about his experience working as a visiting professor in southwest Uganda, Dr. Fred Meier describes many of the challenges in practicing in the resource-limited country … [1]: /embed/inline-graphic-1.gif

Pathology in Southwest Uganda

![Graphic][1] Between August 2014 and July 2015, Dr. Meier taught as a visiting professor at Mbarara University of Science and Technology (MUST) in Uganda, where he mentored pathology resident-equivalents and worked on capacity building in the pathology department. ASCP facilitated support for his time there . MUST, which began 26 years ago as the second medical faculty in Uganda, hosts the Massachusetts General Hospital (MGH) Global Health Collaborative, through which Seed Global Health volunteers come to train and work with Ugandan medical and nursing personnel. As a temporary employee of the pathology department of MGH, I came to Mbarara to contribute to Seed's effort for the academic year 2014-2015. Dr. Meier and Professor Damaris Laffita review a case with MUST pathology MMeds, resident equivalents. My colleagues at MUST included teachers and practitioners from Cuba, Great Britain, Germany, Canada, Australia, New Zealand, and organizations such as Seed and the Peace Corps Response, the latter part of the Global Health Service Partnership. Damaris Laffita, professor of pathology at MUST and an excellent, patient, and kind colleague, is the only full-time onsite pathologist at the university. She combines a knowledge base and technical vocabulary familiar to North American pathologists with experience in making defensible diagnoses in resource-constrained settings, an advantage for practice in Africa. Each semester I taught 20 large-group lectures, all with associated practical sessions. Seventy second-year medical students, as well as another 40 nursing and allied health students, attended lectures on general pathology, and similar numbers of third-year students attended lectures on systemic pathology topics. During the spring 2015 semester, Professor Damaris and I also conducted daylong seminars and tutorials on pathologic topics relevant to residents in surgical specialties (general surgery, obstetrics/gynecology, and ophthalmology) as well as for master's-degree candidates in medical technology. While teaching pathology to medical and other allied health … [1]: /embed/inline-graphic-1.gif

Do Maternal Knowledge and Attitudes towards Childhood Immunizations in Rural Uganda Correlate with Complete Childhood Vaccination?

Improving childhood vaccination coverage and timeliness is a key health policy objective in many developing countries such as Uganda. Of the many factors known to influence uptake of childhood immunizations in under resourced settings, parents’ understanding and perception of childhood immunizations has largely been overlooked. The aims of this study were to survey mothers’ knowledge and attitudes towards childhood immunizations and then determine if these variables correlate with the timely vaccination coverage of their children. From September to December 2013, we conducted a cross-sectional survey of 1,000 parous women in rural Sheema district in southwest Uganda. The survey collected socio-demographic data and knowledge and attitudes towards childhood immunizations. For the women with at least one child between the age of one month and five years who also had a vaccination card available for the child (N = 302), the vaccination status of this child was assessed. 88% of these children received age-appropriate, on-time immunizations. 93.5% of the women were able to state that childhood immunizations protect children from diseases. The women not able to point this out were significantly more likely to have an under-vaccinated child (PR 1.354: 95% CI 1.018–1.802). When asked why vaccination rates may be low in their community, the two most common responses were “fearful of side effects” and “ignorance/disinterest/laziness” (44% each). The factors influencing caregivers’ demand for childhood immunizations vary widely between, and also within, developing countries. Research that elucidates local knowledge and attitudes, like this study, allows for decisions and policy pertaining to vaccination programs to be more effective at improving child vaccination rates.

Hand Eczema in Africa: Clinical Findings and Experiences from South-West Uganda.

Hand Eczema in Africa: Clinical Findings and Experiences from South-West Uganda.