Southwest Uganda Research Articles

Maternal depression and malnutrition in children in southwest Uganda: a case control study.

BackgroundMalnutrition remains one of the most significant child health problems in developing countries with an estimated 53 % of child deaths per year attributed to being underweight. The 2011 Uganda Demographic and Health Survey (UDHS) showed that 38 % of the children were stunted and 16 % were underweight. While dietary and environmental factors are known major contributors to children's nutritional status, maternal depression may also contribute since it disrupts the mothers’ ability to cope with demands of childcare. This study aimed to determine the association between maternal depression and malnutrition in children aged one to 5 years in southwest Uganda.MethodsThe study was undertaken between October and December 2014 on children aged one to 5 admitted to the Mbarara regional referral hospital. Cases were malnourished children and controls were children with other chronic conditions but normal nutritional status admitted to the same hospital. Children’s ages were recorded, weight and height taken and converted into height for age, weight for height and weight for age and malnutrition was determined based on WHO child growth standards. Mothers of both groups of children were assessed for depression using the depression module of the Mini International Neuropsychiatric Interview (MINI). Participants provided informed consent prior to enrollment. The study was approved by Mbarara University of Science and Technology Research Ethics Committee and funded by MicroResearch.ResultsAll 166 mothers who were approached agreed to participate in the study. The prevalence of depression among mothers of malnourished children (86 cases) was 42 % compared to 12 % among mothers of controls (86 controls). The mean age was 25 years (SD 4.43, range 18–40 years). The majority (75 %) were married and most were peasant farmers (62 %). Maternal depression was significantly associated with malnutrition in children with a crude odds ratio of 2.23 (1.08–1.89) and an adjusted odds ratio of 2.4 (1.11–5.18).ConclusionMaternal depression impacts negatively on child nutrition and development as shown by a higher prevalence of depression among mothers of malnourished children compared to the control group. Routine screening and treatment for depression should be included in all maternal and child health clinics.

From Learning to Empowerment: A study of smallholder farmers in South West Uganda

The relationship between education and empowerment has been widely debated in development literature. In recent times, social capital and community-centric learning have been increasingly recognized as important variables in the empowerment process. This paper outlines the development of a Three-dimensional Framework for Empowerment, and looks at the relationship between a community-centric learning process and empowerment in selected villages in Uganda. Based on a comparative study of two villages, the paper evaluates the role of the Lifelong Learning for Farmers (L3F) programme, developed and supported by the Commonwealth of Learning (COL), in empowering farming communities. The study shows that the integration of human capital (viewed purely from learning, knowledge acquisition, reflective practices, skills and competencies) social capital and financial capital, has a positive impact on development outcomes such as empowerment.

Tangible benefits or token gestures: does Bwindi impenetrable National Park's long established multiple use programme benefit the poor?

Trade and use of Non-timber forest products (NTFPs) has often been suggested as a means through which forest dependent people can improve their livelihoods to overcome poverty. Many projects have indeed promoted trade and use of NTFPs as a means of achieving development and conservation goals. One of the earliest large-scale initiatives to explore this was the Bwindi's Multiple Use programme (MUP) in Southwest Uganda that began in 1994. The MUP allows limited park access by local people for medicine and basketry plants, and beekeeping. Here, we assess the development benefits obtained by local people through the MUP two decades after its introduction. Using data from 384 randomly sampled households and repeated market surveys over a 1-year period, we determined household preferences, dependency and incomes from NTFPs. The NTFPs that are most preferred by local people are those prohibited by park management. Furthermore, the highest income per household from NTFPs trade was estimated at 119 US $ per annum (14% of total household income). Restrictive policies on NTFPs extraction curtail tangible benefits to the local people. Restrictions ensure that NTFPs use cannot be increased, thus, despite their significant contribution to welfare, Bwindi's NTFPs remain of negligible value for improving livelihoods.

Esophageal Squamous Cell Carcinoma in a Regional Referral Hospital in Southwest Uganda

Introduction: Despite an increase in esophageal adenocarcinoma, esophageal squamous cell carcinoma remains the predominant type of esophageal cancer worldwide. In Sub-Saharan Africa, the incidence of esophageal cancer has regional variation with southern and eastern regions reporting higher incidence rates. Regional variations also exist within countries. These variations may be due to differences in risk factor profiles. Though esophageal cancer is the second most commonly diagnosed cancer and second highest cause of cancer deaths among East African men, little is known about region specific risk factors. We aim to determine risk factors associated with esophageal squamous cell carcinoma in southwestern Uganda. Methods: We conducted a case-control study of patients presenting for upper endoscopic examination from 2003 to 2014 at Mbarara Regional Referral Hospital, located in southwestern Uganda. Demographic and social data were collected prior to endoscopy and included age, gender, smoking status and alcohol use. Patients with gastric cancer or peptic ulcer disease by histopathological examination or missing results were excluded. Cases were those with a histological diagnosis of esophageal squamous cell carcinoma. Controls were participants with normal endoscopies or gastritis. We used logistic regression to assess for association between age, sex, alcohol intake, and smoking with esophageal squamous cell carcinoma. Results: Our study consisted of 67 cases and 177 controls with a median age of 51 years (IQR 40 - 64); and male predominance (59.43%). Indications for endoscopy differed significantly between cases and controls. Dysphagia and/or odynophagia were more frequent endoscopic indications in cases compared to controls (72.29% vs 5.56%, p < 0.0001). Male gender (AOR 16.46 (3.21 - 84.48), p=0.001), age group of 41 to 50 years (AOR 13.32 (1.16 - 15.3), p=0.038), history of both alcohol and smoking (AOR 4.10, 95%CI (1.14 - 14.78), p=0.031) were associated with esophageal squamous cell carcinoma. Conclusion: Our results emphasize the role of male gender, age, alcohol intake plus smoking as risk factors for esophageal squamous cell carcinoma in this population. Symptoms of dysphagia and/or odynophagia were significantly more frequent among those with squamous cell carcinoma. Expediency and priority should be taken in screening for esophageal cancer in this region and men presenting with dysphagia and a history of alcohol and tobacco use should be prioritized for evaluation.Figure 1

Traditional Rituals and Customs for Pregnant Women in Selected Villages in Southwest Uganda.

Traditional Rituals and Customs for Pregnant Women in Selected Villages in Southwest Uganda.

Epidemiology of HBV infection in a cohort of Ugandan HIV-infected patients and rate and pattern of lamivudine-resistant HBV infection in patients receiving antiretroviral therapy.

Many HIV-infected patients in sub-Saharan Africa are not routinely screened for hepatitis B virus (HBV) infection and are on antiretroviral therapy (ART) regimens containing only lamivudine as anti-HBV active drug. In 2009-2011, we screened for hepatitis B surface antigen (HBsAg) in 2820 HIV-infected adults patients at the Mbarara Hospital Uganda and investigated risk factors for HBV infection. Using samples of dried plasma or blood spots, we tested for HBV viral load and HBV drug resistance mutations in all HBsAg-positive patients on ART for ≥ 12 months. In this study, 109 patients tested HBsAg positive (3.9%; 109/2820). HBsAg-positive patients were more likely to have had >4 lifetime sexual partners (p<0.01). Of the 55 HBsAg-positive patients on ART for ≥ 12 months, 53 were only on lamivudine as anti-HBV active drug and two were on tenofovir and lamivudine. HBV-DNA was detected in 30 patients (54.5%; 30/55), all on lamivudine-monotherapy. Of the 23 patients in whom HBV-DNA sequencing was successful, 17 had lamivudine-resistant HBV strains harbouring rtM204V/I mutations accompanied by secondary/compensatory mutations. Our study suggests that sexual transmission may represent a major mode of spread of HBV in southwest Uganda and confirms the importance of screening for HBV and of using ART regimens containing tenofovir in HIV/HBV co-infected patients.

Nursing curriculum development in remote southwest Uganda.

To describe an intercollaborative outreach between the USA and a school of nursing in Uganda. Ugandan nurses are essential providers of health care in remote regions. High vacancy rates in health centers impacts care in rural areas. A 112-bed health center in southwest Uganda supports village health teams that visit remote villages and provides medical, surgical, and maternal-child services to a population of 250,000. A new Ugandan school of nursing has aligned with the hospital to prepare graduates to provide primary care in remote villages. A team from the USA visited the school and hospital to assess the curriculum and offer educational strategies and support to the school's leadership. Provision of primary health care in the developing world is a longstanding global priority. Nurses are at the center of primary care in remote regions. Educational support for advanced nursing and strategic international relationships can positively impact nursing education in both high and low-income countries. The USA team took part in assessments, teaching, simulation, and remote village outreach. Educational strategies and modalities were shared. The Ugandan nursing school is established and affiliated with another Ugandan university. Standardized curriculum is in place, however continued collaboration is needed for program adaptation to accommodate the unique border region environment. Intercollaborative sharing of information and resources between schools of nursing can have a direct impact on global health initiatives in both high-income and low-income countries.

‘Time for School’? School fees, savings clubs and social reciprocity in Uganda

The past 25 years have witnessed sweeping educational reforms in Uganda. The introduction of ‘free’ Universal Primary Education (UPE, in 1998) and Universal Secondary Education (USE, in 2007) has raised social expectations about access to quality education. Over the same period the population of young people in Uganda has also grown dramatically. As a result hundreds of new primary and secondary schools have been established across the country. This article examines the social and economic consequences for a rural part of Southwest Uganda. Bringing together secondary data from national household surveys with detailed ethnographic research, the article highlights families’ material and social investments in schooling. It explores the costs faced by even the poorest households whose children attend ‘free’ government schools. Despite public investment, the poor quality of state provision has led to public frustration and demands for reforms. Survey data demonstrate that, as a result, wealthier households are investing in education, sending their children to private schools to benefit from smaller class sizes and better learning outcomes. The article describes how people use a range of social arrangements, including rotating savings and credit associations to manage school fees and access credit in this part of Uganda. Drawing on recent work by Graeber and others, we argue that people are creating new social relationships within these savings clubs. Whilst managing their financial commitments, people invoke and rework existing idioms of reciprocity, interdependence and patronage. The use of human capital theory to explain schooling choices in relation to individual economic or social ‘returns’ downplays the sociality of these arrangements. We argue that educational commitments are now an integral part of the Ugandan social landscape, generating aspiration, nurturing networks and creating new inequalities.

Prevalence of HIV-related thrombocytopenia among clients at Mbarara Regional Referral Hospital, Mbarara, southwestern Uganda.

Aims/objectivesWe aimed to determine the prevalence and correlates of thrombocytopenia among people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and to assess occurrence of antiplatelet antibodies, among thrombocytopenic HIV clients at Mbarara Regional Referral Hospital, southwestern Uganda.Materials and methodsThis was a retrospective review of hematologic results at enrollment to HIV care from 2005 to 2013. The prevalence and correlates of thrombocytopenia were estimated based on the Immune Suppressed Syndrome (ISS) Clinic electronic database. A cross-sectional study determined the occurrence of antiplatelet antibodies, using the monoclonal antibody-specific immobilization of platelet antigens (MAIPA) technique.ResultsWe reviewed 15,030 client records. The median age was 35.0 (range 18–78; interquartile range [IQR] 28–42) years, and there were 63.2% (n=9,500) females. The overall prevalence of thrombocytopenia was 17.4% (95% confidence interval [CI]: 16.8%–18.0%). The prevalence of thrombocytopenia was 17.8% (95% CI: 17.1%–18.4%) among antiretroviral therapy (ART)-naïve clients (n=2,675) and was 13.0% (95% CI: 0.3%–21.9%) for clients who were on ART (n=6). The study found a significant association between thrombocytopenia and other cytopenias, CD4 counts, ART, and deteriorating HIV stage (P<0.05). Two of the 40 participants (5.0%) had antiplatelet antibodies.ConclusionThis study has showed a high prevalence of HIV-related thrombocytopenia. Antiplatelet antibodies were found in 5.0% of HIV-infected thrombocytopenic participants. Our study shows a significant association of thrombocytopenia burden in a high-HIV study population (Southwest Uganda); therefore, there is need to monitor platelet counts and initiate platelet transfusion in our blood banking practices, to avert possible risks of bleeding.

Three New Aloe Records from Uganda (Xanthorrhoeaceae)

Three new Aloe records for Uganda are described. A. lolwensis Newton is found in southeast Uganda, A. bukobana Reynolds in southwest Uganda and A. macleayi Reynolds in the far north, very close to the South Sudanese border. A. macleayi in Uganda is also a new record for the Flora of Tropical East Africa.

Impact of papyrus wetland encroachment on spatial and temporal variabilities of stream flow and sediment export from wet tropical catchments

During the past decades, land use change in the Lake Victoria basin has significantly increased the sediment fluxes to the lake. These sediments as well as their associated nutrients and pollutants affect the food and water security of millions of people in one of Africa's most densely populated regions. Adequate catchment management strategies, based on a thorough understanding of the factors controlling runoff and sediment discharge are therefore crucial. Nonetheless, studies on the magnitude and dynamics of runoff and sediment discharge are very scarce for the Lake Victoria basin and the African Rift region.We therefore conducted runoff discharge and sediment export measurements in the Upper Rwizi, a catchment in Southwest Uganda, which is representative for the Lake Victoria basin. Land use in this catchment is characterized by grazing area on the high plateaus, banana cropping on the slopes and Cyperus papyrus L. wetlands in the valley bottoms. Due to an increasing population pressure, these papyrus wetlands are currently encroached and transformed into pasture and cropland. Seven subcatchments (358km2–2120km2), with different degrees of wetland encroachment, were monitored during the hydrological year June 2009–May 2010.Our results indicate that, due to their strong buffering capacity, papyrus wetlands have a first-order control on runoff and sediment discharge. Subcatchments with intact wetlands have a slower rainfall–runoff response, smaller peak runoff discharges, lower rainfall–runoff ratios and significantly smaller suspended sediment concentrations. This is also reflected in the measured annual area-specific suspended sediment yields (SYs): subcatchments with encroached papyrus swamps have SY values that are about three times larger compared to catchments with intact papyrus vegetation (respectively 106–137tonkm−2y−1 versus 34–37tonkm−2y−1). We therefore argue that protecting and (where possible) rehabilitating these papyrus wetlands should be a corner stone of catchment management strategies in the Lake Victoria basin.

Mitigating the impact of the epidemic on the households and families of older people in rural Uganda: lessons for social protection

Using quantitative and qualitative data drawn from a population cohort of 20,000 people in South-West Uganda we explored factors (household size/dependency ratios/ residence patterns/ socio-economic status) which may have exacerbated or eased the impact of the AIDS epidemic for older people (70 years and older). We found that higher socio-economic status, large family size and reciprocal relationships with kin/neighbours were particularly important in shielding older people from the negative effects of AIDS-related deaths among their children; elders without these fared badly. Our findings provide pointers for the targeting of social protection for older people in such resource-constrained settings.

REDD at the crossroads? The opportunities and challenges of REDD for conservation and human welfare in South West Uganda

Reducing emissions from deforestation and forest degradation (REDD) in the tropics could slow climate change while contributing to biodiversity conservation and to improvement of people's livelihoods. In this study, we assessed the opportunities and challenges of implementing REDD in South West (SW) Uganda. We consulted key stakeholders and reviewed regional literature particularly focusing on the opportunities for conservation and human welfare benefits. We structured our study using the Simpson and Vira's (2010) framework for assessing policy interventions. The leading drivers of forest loss and degradation include escalating timber trade, fuel-wood extraction and agricultural expansion. Forestry authorities were poorly funded, largely uncoordinated and widely accused of corruption. Land tenure was a concern with many de-facto owners lacking legal titles. Generally, local stakeholders had limited awareness of REDD, and local expectations appeared un-realistically high. Mechanisms for allocating and administering REDD payments remained unknown. However, civil society organisations appeared the most popular option to manage REDD funding as government agencies had limited credibility. For REDD to succeed, the challenges we have highlighted will need to be addressed: key to success will be improvements in foundational knowledge, enabling institutions and social conditions. Our results have implications for potential REDD activities around the world which face similar challenges.

Teaching by Teleconference: A Model for Distance Medical Education across Two Continents.

IntroductionIn Uganda, an estimated 120 obstetrician/gynecologists serve a population of 30 million people demonstrating the need to train additional skilled clinician leaders in reproductive health. In 2012, a partnership was formed with the Mbarara Regional Referral Hospital (MRRH) in southwest Uganda and the Massachusetts General Hospital (MGH) in Boston, USA, in part to increase access to specialist training. This report presents an update in the development of a teaching conference between the institutions.MethodsIn June 2012, a didactic teleconference between the institutions was instituted. Various conferencing tools were tried: direct telephone connection, Ventrilo™ conferencing system and Skype™ via personal computer or smart phone. In Mbarara, Internet was accessed via cellular data. In Boston, Internet was accessed via hospital network or cellular data. All lectures were HIPAA compliant. PowerPoint lectures were stored in a collective Dropbox™ that could be accessed and downloaded prior to lecture dates.ResultsOver 30 months, 30 lectures were given. Lecturers included faculty and fellows from maternal fetal medicine, gynecology oncology, urogynecology, family planning, psychiatry and obstetric anesthesia. A patient case pertinent to the teaching topic framed the discussion. About 20 participants attended each lecture. Internet connectivity was the biggest challenge. Ultimately audio Skype via cellular data proved the most successful modality and became the method of choice.ConclusionA successful collaboration in medical education via teleconference is sustainable, low cost, and beneficial to both resource-rich and resource-poor institutions. Expertise can be shared bilaterally and internationally by individuals potentially unable travel.

Evaluating coffee yield gaps and important biotic, abiotic, and management factors limiting coffee production in Uganda

Coffee is Uganda’s biggest export commodity, produced mainly by an estimated one million smallholder farmers (<2.5ha). Arabica (Coffea arabica L.) and Robusta (Coffea canephora Pierre ex Froehn.) are the two coffee species grown. Robusta is dominantly cultivated at lower elevations (<1400m) such as in Central and Northern Uganda and Arabica is dominant at higher elevations (>1400m) such as Eastern, Southwest, and Northwest Uganda. Actual yields are far below (<30%) potential due to various biotic, abiotic, and management constraints, yet there is no quantitative information on site-specific production constraints and the yield gaps attributed to those constraints. In this study, yields and diverse production factors were monitored in 254 plots of five major coffee growing regions (i.e., Central, North, East, Southwest, and Northwest). Boundary line analysis was applied to evaluate the relative importance of the individual production factors in limiting coffee production and to quantify the associated yield gaps at regional level. The impacts of rainfall variation on coffee yield were evaluated separately by regression analysis. The results of boundary line analysis indicated that biotic constraints (coffee twig borer) and poor management practices (unproductive coffee trees and low coffee plant density) restricted Robusta production in the Central region; poor soil nutrient status (especially potassium) and lack of mulching were the causes of yield loss of Robusta grown in the Northern region. For Arabica, unfavorable soil properties (high soil pH and phosphorus concentration) and excessive number of shade trees were the most important constraints in the East; high soil magnesium concentration and poor mulching limited coffee yield in the Southwest; poor soil nutrient status (especially phosphorus and potassium) and low coffee plant density were the important yield limitations in the Northwest. Average explained yield gaps of individual coffee plot due to the most important production constraints were 45%, 52%, 57%, 49%, and 50% of attainable yield, respectively, in the Central, Northern, Eastern, Southwest, and Northwest regions. Considerably less annual precipitation was received in 2009/2010 coffee growing season compared with that in the previous three years (2006–2008). Seasonal rainfall shortage occurred in the Southwest was a significant limitation to Arabica production, while excessive rainfall across the whole growing season was associated with yield reduction in the Eastern and Northwest regions. We conclude that there was a large yield gap for both Robusta and Arabica coffee grown in Uganda. Boundary line analysis allows the evaluation of relative importance of individual production constraint directly in the plot. The important production constraints varied strongly depending on the regions, which calls for site-specific management implementations. Soil fertility can be improved by implementing integrated soil fertility management (ISFM) that makes use of nutrients from the soil, recycled crop residues, mulch and chemical fertilizers. Attentions should also be given to other management practices such as coffee plant density, unproductive coffee trees and shade trees etc.

Qualitative study of changes in alcohol use among HIV-infected adults entering care and treatment for HIV/AIDS in rural southwest Uganda.

Alcohol has a substantial negative impact on the HIV epidemic in sub-Saharan Africa, particularly in Uganda, where heavy alcohol consumption is common. Using a content analytic approach, this qualitative study characterizes changes in alcohol use among 59 HIV-infected Ugandan adults (>18 years old), who reported any alcohol use in the previous year as they entered HIV care. Most participants reported attempting to cease or reduce alcohol intake over the study period. Reasons for decreased use included advice from clinicians, interference with social obligations, threats to financial security, and negative impact on social standing. Participants reported difficulty abstaining from alcohol, with incentives to continue drinking including desire for social inclusion, stress relief, and enjoyment of alcohol. These contrasting incentives created a moral quandary for some participants, who felt ‘pulled’ between ‘good’ and ‘bad’ influences. Results suggest brief interventions addressing self-identified obstacles to change may facilitate long-term reductions in drinking in this population.

Drugs for some but not all: inequity within community health worker teams during introduction of integrated community case management.

BackgroundThe Ugandan health system now supports integrated community case management (iCCM) by community health workers (CHWs) to treat young children ill with fever, presumed pneumonia, and diarrhea. During an iCCM pilot intervention study in southwest Uganda, two CHWs were selected from existing village teams of two to seven CHWs, to be trained in iCCM. Therefore, some villages had both ‘basic CHWs’ who were trained in standard health promotion and ‘iCCM CHWs’ who were trained in the iCCM intervention. A qualitative study was conducted to investigate how providing training, materials, and support for iCCM to some CHWs and not others in a CHW team impacts team functioning and CHW motivation.MethodsIn 2012, iCCM was implemented in Kyabugimbi sub-county of Bushenyi District in Uganda. Following seven months of iCCM intervention, focus group discussions and key informant interviews were conducted alongside other end line tools as part of a post-iCCM intervention study. Study participants were community leaders, caregivers of young children, and the CHWs themselves (‘basic’ and ‘iCCM’). Qualitative content analysis was used to identify prominent themes from the transcribed data.ResultsThe five main themes observed were: motivation and self-esteem; selection, training, and tools; community perceptions and rumours; social status and equity; and cooperation and team dynamics. ‘Basic CHWs’ reported feeling hurt and overshadowed by ‘iCCM CHWs’ and reported reduced self-esteem and motivation. iCCM training and tools were perceived to be a significant advantage, which fueled feelings of segregation. CHW cooperation and team dynamics varied from area to area, although there was an overall discord amongst CHWs regarding inequity in iCCM participation. Despite this discord, reasonable personal and working relationships within teams were retained.ConclusionsTraining and supporting only some CHWs within village teams unexpectedly and negatively impacted CHW motivation for ‘basic CHWs’, but not necessarily team functioning. A potential consequence might be reduced CHW productivity and increased attrition. CHW programmers should consider minimizing segregation when introducing new program opportunities through providing equal opportunities to participate and receive incentives, while seeking means to improve communication, CHW solidarity, and motivation.

The practice of traditional rituals and customs in newborns by mothers in selected villages in southwest Uganda

Between 1990 and 2011, neonatal mortality dropped from 32 to 22 per 1000 live births globally, but has remained above 30 per 1000 live births in Africa. Many neonatal deaths are preventable with support for healthy pregnancies, deliveries and newborn care. Continuation of traditional pregnancy/birth rituals may be placing some mothers/neonates at risk. The Ankole region of Uganda has a population of approximately eight million, and approximately 10,000 live referral hospital births annually. However, most babies are born at home in their villages because women avoid going to the hospital unless complications occur. The purpose of the present study was to determine what potentially harmful traditional pregnancy/birth rituals were practiced in the Ankole region, and to develop Village Health Team (VHT; volunteer community workers with limited health training) mitigation strategies.

Mortality and its predictors among antiretroviral therapy naïve HIV-infected individuals with CD4 cell count ≥350 cells/mm3 compared to the general population: data from a population-based prospective HIV cohort in Uganda

Background Evidence exists that even at high CD4 counts, mortality among HIV-infected antiretroviral therapy (ART) naïve individuals is higher than that in the general population. However, many developing countries still initiate ART at CD4 ≤350 cells/mm3. Objective To compare mortality among HIV-infected ART naïve individuals with CD4 counts ≥350 cells/mm3 with mortality in the general Ugandan population and to investigate risk factors for death. Design Population-based prospective HIV cohort. Methods The study population consisted of HIV-infected people in rural southwest Uganda. Patients were reviewed at the study clinic every 3 months. CD4 cell count was measured every 6 months. Rate ratios were estimated using Poisson regression. Indirect methods were used to calculate standardised mortality ratios (SMRs). Results A total of 374 participants with CD4 ≥350 cells/mm3 were followed for 1,328 person-years (PY) over which 27 deaths occurred. Mortality rates (MRs) (per 1,000 PY) were 20.34 (95% CI: 13.95–29.66) among all participants and 16.43 (10.48–25.75) among participants aged 15–49 years. Mortality was higher in periods during which participants had CD4 350–499 cells/mm3 than during periods of CD4 ≥500 cells/mm3 although the difference was not statistically significant [adjusted rate ratio (aRR)=1.52; 95% CI: 0.71–3.25]. Compared to the general Ugandan population aged 15–49 years, MRs were 123% higher among participants with CD4 ≥500 cells/mm3 (SMR: 223%, 95% CI: 127–393%) and 146% higher among participants with CD4 350–499 cells/mm3 (246%, 117%–516). After adjusting for current age, mortality was associated with increasing WHO clinical stage (aRR comparing stage 3 or 4 and stage 1: 10.18, 95% CI: 3.82–27.15) and decreasing body mass index (BMI) (aRR comparing categories ≤17.4 Kg/m2 and ≥18.5 Kg/m2: 6.11, 2.30–16.20). Conclusion HIV-infected ART naïve individuals with CD4 count ≥350 cells/mm3 had a higher mortality than the general population. After adjusting for age, the main predictors of mortality were WHO clinical stage and BMI.

Associations between mass media exposure and birth preparedness among women in southwestern Uganda: a community-based survey

Background Exposure to mass media provides increased awareness and knowledge, as well as changes in attitudes, social norms and behaviors that may lead to positive public health outcomes. Birth preparedness (i.e. the preparations for childbirth made by pregnant women, their families, and communities) increases the use of skilled birth attendants (SBAs) and hence reduces maternal morbidity and mortality. Objective The aim of this study was to explore the association between media exposure and birth preparedness in rural Uganda. Method A total of 765 recently delivered women from 120 villages in the Mbarara District of southwest Uganda were selected for a community-based survey using two-stage cluster sampling. Univariate and multivariate logistic regression was performed with generalized linear mixed models using SPSS 21. Results We found that 88.6% of the women surveyed listened to the radio and 33.9% read newspapers. Birth preparedness actions included were money saved (87.8%), identified SBA (64.3%), identified transport (60.1%), and purchased childbirth materials (20.7%). Women who had taken three or more actions were coded as well birth prepared (53.9%). Women who read newspapers were more likely to be birth prepared (adjusted OR 2.2, 95% CI 1.5–3.2). High media exposure, i.e. regular exposure to radio, newspaper, or television, showed no significant association with birth preparedness (adjusted OR 1.3, 95% CI 0.9–2.0). Conclusion Our results indicate that increased reading of newspapers can enhance birth preparedness and skilled birth attendance. Apart from general literacy skills, this requires newspapers to be accessible in terms of language, dissemination, and cost.