Live bird markets (LBMs) are essential for marketing poultry, but have been linked to many outbreaks of avian influenza (AI) and its spread. In Uganda, it has been observed that demographic ...characteristics of poultry traders/handlers influence activities and decision‐making in LBMs. The study investigated the influence of socio‐demographic characteristics of poultry handlers: age, sex, religion, educational background, level of income, location of residence and region of operation on 20 potential risk factors for introduction and spread of AI in LBMs. Study sites included 39 LBMs in the four regions of Uganda. Data was collected using a semi‐structured questionnaire administered to 424 poultry handlers. We observed that background of education was a predictor for slaughter and processing of poultry in open sites. Location of residence was associated with slaughter of poultry from open sites and selling of other livestock species. Region influenced stacking of cages, inadequate cleaning of cages, feeders and drinkers, and provision of dirty feed and water. Specifically, bird handlers with secondary level of education (OR = 12.9, 95% CI: 2.88–57.4, P < 0.01) were more likely to be involved in open site slaughter of poultry than their counterparts without formal education. Comparatively, urbanite bird handlers were less likely to share poultry equipment (OR = 0.4, 95% CI: 0.22–0.63, P < 0.01) than rural resident handlers. Poultry handlers in Northern were 3.5 times more likely to practise insufficient cleaning of cages (OR = 3.5, 95% CI: 1.52–8.09) compared to those in Central region. We demonstrated that some socio‐demographic characteristics of poultry handlers were predictors to risky practices for introduction and spread of AI viruses in LBMs in Uganda.
Background. Untreated human immunodeficiency virus type 1 (HIV) infection is associated with persistent immune activation, which is an independent driver of disease progression in European and United ...States cohorts. In Uganda, HIV-1 subtypes A and D and recombinant AD viruses predominate and exhibit differential rates of disease progression. Methods. HIV-1 seroconverters (n = 156) from rural Uganda were evaluated to assess the effects of T-cell activation, viral load, and viral subtype on disease progression during clinical follow-up. Results. The frequency of activated T cells was increased in HIV-1-infected Ugandans, compared with community matched uninfected individuals, but did not differ significantly between viral subtypes. Higher HIV-1 load, subtype D, older age, and high T-cell activation levels were associated with faster disease progression to AIDS or death. In a multivariate Cox regression analysis, HIV-1 load was the strongest predictor of progression, with subtype also contributing. T-cell activation did not emerge an independent predictor of disease progression from this particular cohort. Conclusions. These findings suggest that the independent contribution of T-cell activation on morbidity and mortality observed in European and North American cohorts may not be directly translated to the HIV epidemic in East Africa. In this setting, HIV-1 load appears to be the primary determinant of disease progression.
Squamous cell carcinoma of the conjunctiva (SCCC) is associated with HIV-related immunosuppression, but human papillomavirus virus (HPV) is also suspected to have a role. We carried out a ...case-control study to assess the role of cutaneous and mucosal HPV types in SCCC, conjunctival dysplasia, and their combination (SCCC/dysplasia) in Uganda.
We compared HPV prevalence in frozen biopsies from 94 SCCC cases (79 of whom were found to be HIV-positive), 39 dysplasia cases (34 HIV-positive), and 285 hospital controls (128 HIV-positive) having other eye conditions that required surgery. Highly sensitive PCR assays that detect 75 HPV types were used. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed, adjusting for, or stratifying by age, sex, and HIV status.
Cutaneous HPV types were detected in 45% of SCCC cases, 41% of dysplasia cases and 11% of controls. Human papillomavirus virus 5 and 8 were the most common types in SCCC, and most often occurred in combination with other types. Associations were observed between SCCC/dysplasia and detection of both single (OR=2.3; 1.2-4.4) and multiple (OR=18.3; 6.2-54.4) cutaneous HPV types, and were chiefly based on findings in HIV-positive patients. Cutaneous HPV infections were rarely observed among HIV-negative patients and the association with SCCC/dysplasia was not significant (OR=2.4; 0.6-9.6) among them. Squamous cell carcinoma of the conjunctiva/dysplasia risk and mucosal HPV types were not associated in either HIV-positive or HIV-negative patients.
We detected cutaneous HPV types in nearly half of SCCC/dysplasia cases and often multiple types (HPV5 and 8 being most common). The role of HIV (confounder or strong enhancer of cutaneous HPV carcinogenicity) is still uncertain.
Aim
To describe the functional limitations and associated impairments of children with cerebral palsy (CP) in rural Uganda, and care‐seeking behaviour and access to assistive devices and education.
...Method
Ninety‐seven children with CP (42 females, 55 males; age range 2–17y) were identified in a three‐stage population‐based screening with subsequent medical examinations and functional assessments. Information on school and access to care was collected using questionnaires. The data were compared with Swedish and Australian cohorts of children with CP. We used the χ2 test and linear regression models to analyse differences between groups.
Results
Younger children were more severely impaired than older children. Two‐fifths of the children had severe impairments in communication, about half had intellectual disability, and one third had seizures. Of 37 non‐walking children, three had wheelchairs and none had walkers. No children had assistive devices for hearing, seeing, or communication. Care‐seeking was low relating to lack of knowledge, insufficient finances, and ‘lost hope'. One‐third of the children attended school. Ugandan children exhibited lower developmental trajectories of mobility and self‐care than a Swedish cohort.
Interpretation
The needs for children with CP in rural Uganda are not met, illustrated by low care‐seeking, low access to assistive devices, and low school attendance. A lack of rehabilitation and stimulation probably contribute to the poor development of mobility and self‐care skills. There is a need to develop and enhance locally available and affordable interventions for children with CP in Uganda.
What this paper adds
Development of mobility and self‐care skills is lower in Ugandan than Swedish children with cerebral palsy (CP).
Older children in Uganda with CP are less impaired than younger children.
Untreated seizures and impairments of communication and intellect are common.
Access to health services, assistive devices, and education is low.
Caregivers lack knowledge and finances to seek care and often lose hope of their child improving.
Resumen
Deficiencias, limitaciones funcionales y acceso a servicios de salud y educación en Uganda para niños con parálisis cerebral: un estudio basado en la población
Objetivo
Describir las limitaciones funcionales y las deficiencias asociadas en niños con parálisis cerebral (PC) en las zonas rurales de Uganda, y el comportamiento de búsqueda y acceso a la atención y a dispositivos de tecnología asistiva y educación.
Metodo
Se realizó una pesquisa poblacional en tres etapas con exámenes médicos y evaluaciones funcionales. Se identificaron 97 niños y niñas con PC (42 mujeres, 55 varones; rango de edad de 2 a 17 años). La información sobre el acceso a la escuela y a la atención se obtuvo mediante cuestionarios. Los datos obtenidos se compararon con cohortes suecas y australianas de niños con PC. Utilizamos la prueba de Chi2 y modelos de regresión lineal para analizar las diferencias entre los grupos.
Resultados
Los niños más pequeños tenían deficiencias más graves que los niños mayores. Dos quintos de los niños tenían impedimentos severos en la comunicación, aproximadamente la mitad tenía discapacidad intelectual y un tercio tenía convulsiones. De los 37 niños que no caminaban, tres tenían sillas de ruedas, ninguno tenía andadores y ninguno tenía dispositivos de asistencia para escuchar, ver o comunicarse. El comportamiento de búsqueda de atención fue bajo y se relacionó con la falta de conocimiento, con ingresos económicos insuficientes y con la "pérdida de esperanza". Un tercio de los niños asistían a la escuela. Los niños ugandeses exhibieron trayectorias de movilidad y autocuidado con menor desarrollo que una cohorte sueca.
Interpretacion
Las necesidades de los niños con PC en las zonas rurales de Uganda no son satisfechas. Esto lo demuestra la baja búsqueda de atención, el acceso limitado a dispositivos de asistencia y el bajo nivel de asistencia a la escuela. La falta de rehabilitación y estimulación probablemente contribuyan al pobre desarrollo de la movilidad y de las habilidades de autocuidado. Existe la necesidad de desarrollar y mejorar las intervenciones locales disponibles y asequibles para niños con PC en Uganda.
Resumo
Deficiências, limitações funcionais, e acesso a serviços e educação de crianças com paralisia cerebral em Uganda: um estudo populacional
Objetivo
Descrever as limitações funcionais e deficiências associadas de crianças com paralisia cerebral (PC) em Uganda rural, e o comportamento de busca por cuidados e acesso a dispositivos assitivos e educação.
Método
Noventa e sete crianças com PC (42 do sexo feminino, 55 do sexo masculino; variação de idade 2–17a) foram identificadas em um levantamento populacional em três estágios com exames médicos e avaliações funcionais subsequentes. Informações sobre escolas e acesso a cuidados foram coletadas usando questionários. Os dados foram comparados a coortes suecas e australianas de crianças com PC. Usamos o teste 2 e modelos de regressão linear para analisar diferenças entre os grupos.
Resultados
Crianças mais jovens eram mais severamente comprometidas do que as mais velhas. Dois quintos das crianças tinham deficiências severas na comunicação, cerca de metade tinha deficiência intelectual, e um terço tinha crises convulsivas. Das 37 não deambuladoras, três tinham cadeiras de rodas, nenhuma tinha andadores, e nenhuma tinha dispositivos assistivos para audição, visão ou comunicação. A busca por cuidados foi baixa, relacionando‐se com falta de conhecimento, recursos financeiros insufucientes, e “perda de esperança”. Um terço das crianças frequentava escolas. Crianças de Uganda exibiram trajetórias desenvolvimentais mais baixas em mobilidade e auto‐cuidado do que a coorte sueca.
Interpretação
As necessidades de crianças com PC em Uganda não são atendidas, ilustradas por baixa busca por cuidados, baixo acesso a dispositivos assistivos, e baixa inserção escolar. A falta de reabilitação e estimulação provavelmente contribuem para o menor desenvolvimento de habilidades de mobilidade e auto‐cuidado. Há necessidade de desenvolver e melhorar intervenções localmente disponíveis e acessíveis para crianças com PC em Uganda.
What this paper adds
Development of mobility and self‐care skills is lower in Ugandan than Swedish children with cerebral palsy (CP).
Older children in Uganda with CP are less impaired than younger children.
Untreated seizures and impairments of communication and intellect are common.
Access to health services, assistive devices, and education is low.
Caregivers lack knowledge and finances to seek care and often lose hope of their child improving.
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This article is commented on by Yeargin‐Allsopp on page 407 of this issue.
BackgroundWe estimated rates of human immunodeficiency virus (HIV)–1 transmission per coital act in HIV-discordant couples by stage of infection in the index partner MethodsWe retrospectively ...identified 235 monogamous, HIV-discordant couples in a Ugandan population-based cohort. HIV transmission within pairs was confirmed by sequence analysis. Rates of transmission per coital act were estimated by the index partner’s stage of infection (recent seroconversion or prevalent or late-stage infection). The adjusted rate ratio of transmission per coital act was estimated by multivariate Poisson regression ResultsThe average rate of HIV transmission was 0.0082/coital act (95% confidence interval CI, 0.0039–0.0150) within ∼2.5 months after seroconversion of the index partner; 0.0015/coital act within 6–15 months after seroconversion of the index partner (95% CI, 0.0002–0.0055); 0.0007/coital act (95% CI, 0.0005–0.0010) among HIV-prevalent index partners; and 0.0028/coital act (95% CI, 0.0015–0.0041) 6–25 months before the death of the index partner. In adjusted models, early- and late-stage infection, higher HIV load, genital ulcer disease, and younger age of the index partner were significantly associated with higher rates of transmission ConclusionsThe rate of HIV transmission per coital act was highest during early-stage infection. This has implications for HIV prevention and for projecting the effects of antiretroviral treatment on HIV transmission
Incidence rates of different cancers have been calculated for the population of Kyadondo County (Kampala, Uganda) for four time periods (1960-1966; 1967-1971; 1991-1994; 1995-1997), spanning 38 years ...in total. The period coincides with marked social and lifestyle changes and with the emergence of the AIDS epidemic. Most cancers have increased in incidence over time, the only exceptions being cancers of the bladder and penis. Apart from these, the most common cancers in the early years were cervix, oesophagus and liver; all three have remained common, with the first two showing quite marked increases in incidence, as have cancers of the breast and prostate. These changes have been overshadowed by the dramatic effects of the AIDS epidemic, with Kaposi's sarcoma emerging as the most common cancer in both sexes in the 1990s, and a large increase in incidence of squamous cell cancers of the conjunctiva. In the most recent period, there also seems to have been an increase in the incidence of non-Hodgkin lymphomas. So far, lung cancer remains rare. Cancer control in Uganda, as elsewhere in sub-Saharan Africa, faces a threefold challenge. With little improvement in the incidence of cancers associated with infection and poverty (liver, cervix, oesophagus), it must face the burden of AIDS-associated cancers, while coping with the emergence of cancers associated with Westernization of lifestyles (large bowel, breast and prostate).
The study is a continuation of a research carried out in Luweero district in Uganda1. It investigated whether PHAST was a suitable tool for reducing transmission of soil transmitted helminths. PHAST ...means Participatory Hygiene and Sanitation Transformation; a participatory approach that uses visual tools to stimulate the participation of people in promotion of improved hygiene and sanitation.
To assess the effect of PHAST on intestinal helminth transmission in children under five years.
Three phases namely; (1) Baseline survey (2) PHAST intervention (3) Follow up were conducted. During Phase 1, the subjects' stool samples were examined for presence of helminthic ova and questionnaires administered. In Phase 2, PHAST was conducted only in experimental villages. All subjects in the experimental and control villages were treated thrice with Albendazole. During Phase 3, all steps of Phase 1 were repeated.
There was an overall reduction in the prevalence of children infected with helminths after PHAST intervention. Also, comparison of pre-intervention and post-intervention multivariate results indicates that the likelihood of children getting infected with helminths reduced in most of the experimented variables.
Health stakeholders should utilize PHAST approach to sensitize communities on the importance of hygiene to curb soil-transmitted helminth infections.
Studies from high-income countries reported reduced life expectancy in children with cerebral palsy (CP), while no population-based study has evaluated mortality of children with CP in sub-Saharan ...Africa. This study aimed to estimate the mortality rate (MR) of children with CP in a rural region of Uganda and identify risk factors and causes of death (CODs).
This population-based, longitudinal cohort study was based on data from Iganga-Mayuge Health and Demographic Surveillance System in eastern Uganda. We identified 97 children (aged 2-17 years) with CP in 2015, whom we followed to 2019. They were compared with an age-matched cohort from the general population (n = 41 319). MRs, MR ratios (MRRs), hazard ratios (HRs), and immediate CODs were determined. MR was 3952 per 100 000 person years (95% CI 2212-6519) in children with CP and 137 per 100 000 person years (95% CI 117-159) in the general population. Standardized MRR was 25·3 in the CP cohort, compared with the general population. In children with CP, risk of death was higher in those with severe gross motor impairments than in those with milder impairments (HR 6·8; p = 0·007) and in those with severe malnutrition than in those less malnourished (HR = 3·7; p = 0·052). MR was higher in females in the CP cohort, with a higher MRR in females (53·0; 95% CI 26·4-106·3) than in males (16·3; 95% CI 7·2-37·2). Age had no significant effect on MR in the CP cohort, but MRR was higher at 10-18 years (39·6; 95% CI 14·2-110·0) than at 2-6 years (21·0; 95% CI 10·2-43·2). Anaemia, malaria, and other infections were the most common CODs in the CP cohort.
Risk of premature death was excessively high in children with CP in rural sub-Saharan Africa, especially in those with severe motor impairments or malnutrition. While global childhood mortality has significantly decreased during recent decades, this observed excessive mortality is a hidden humanitarian crisis that needs to be addressed.
Background. Human immunodeficiency virus type 1 (HIV-1) subtypes differ in biological characteristics that may affect pathogenicity. Methods. We determined the HIV-1 subtype—specific rates of disease ...progression among 350 HIV-1 seroconverters. Subtype, viral load, and CD4+ cell count were determined. Cox proportional hazards regression modeling was used to estimate adjusted hazard ratios (HRs) of progression to acquired immunodeficiency syndrome (AIDS) (defined as a CD4+ cell count of ⩽250 cells/mm3) and to AIDS-associated death. Results. A total of 59.1% of study subjects had subtype D strains, 15.1% had subtype A, 21.1% had intersubtype recombinant subtypes, 4.3% had multiple subtypes, and 0.3% had subtype C. Of the 350 subjects, 129 (37%) progressed to AIDS, and 68 (19.5%) died of AIDS. The median time to AIDS onset was shorter for persons with subtype D(6.5 years), recombinant subtypes (5.6 years), or multiple subtypes (5.8 years), compared with persons with subtype A (8.0 years; P = .022). Relative to subtype A, adjusted HRs of progression to AIDS were 2.13 95% confidence interval {CI}, 1.10–4.11 for subtype D, 2.16 95% CI, 1.05–4.45 for recombinant subtypes, and 4.40 95% CI, 1.71–11.3 for multiple subtypes. The risk of progression to death was significantly higher for subtype D(adjusted HR, 5.65; 95% CI, 1.37–23.4), recombinant subtypes (adjusted HR, 6.70; 95% CI, 1.56–28.8), and multiple subtypes (adjusted HR, 7.67; 95% CI, 1.27–46.3), compared with subtype A. Conclusions. HIV disease progression is affected by HIV-1 subtype. This finding may impact decisions on when to initiate antiretroviral therapy and may have implications for future trials of HIV-1 vaccines aimed at slowing disease progression.
Few population-based studies of cerebral palsy have been done in low-income and middle-income countries. We aimed to examine cerebral palsy prevalence and subtypes, functional impairments, and ...presumed time of injury in children in Uganda.
In this population-based study, we used a nested, three-stage, cross-sectional method (Iganga-Mayuge Health and Demographic Surveillance System HDSS) to screen for cerebral palsy in children aged 2–17 years in a rural eastern Uganda district. A specialist team confirmed the diagnosis and determined the subtype, motor function (according to the Gross Motor Function Classification System GMFCS), and possible time of brain injury for each child. Triangulation and interviews with key village informants were used to identify additional cases of suspected cerebral palsy. We estimated crude and adjusted cerebral palsy prevalence. We did χ2 analyses to examine differences between the group screened at stage 1 and the entire population and regression analyses to investigate associations between the number of cases and age, GMFCS level, subtype, and time of injury.
We used data from the March 1, 2015, to June 30, 2015, surveillance round of the Iganga-Mayuge HDSS. 31 756 children were screened for cerebral palsy, which was confirmed in 86 (19%) of 442 children who screened positive in the first screening stage. The crude cerebral palsy prevalence was 2·7 (95% CI 2·2–3·3) per 1000 children, and prevalence increased to 2·9 (2·4–3·6) per 1000 children after adjustment for attrition. The prevalence was lower in older (8–17 years) than in younger (<8 years) children. Triangulation added 11 children to the cohort. Spastic unilateral cerebral palsy was the most common subtype (45 46% of 97 children) followed by bilateral cerebral palsy (39 40% of 97 children). 14 (27%) of 51 children aged 2–7 years had severe cerebral palsy (GMFCS levels 4–5) compared with only five (12%) of 42 children aged 8–17 years. Few children (two 2% of 97) diagnosed with cerebral palsy were born preterm. Post-neonatal events were the probable cause of cerebral palsy in 24 (25%) of 97 children.
Cerebral palsy prevalence was higher in rural Uganda than in high-income countries (HICs), where prevalence is about 1·8–2·3 cases per 1000 children. Children younger than 8 years were more likely to have severe cerebral palsy than older children. Fewer older children than younger children with cerebral palsy suggested a high mortality in severely affected children. The small number of preterm-born children probably resulted from low preterm survival. About five times more children with post-neonatal cerebral palsy in Uganda than in HICs suggested that cerebral malaria and seizures were prevalent risk factors in this population.
Swedish Research Council, Promobilia.
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