Adolescent girls and young women (AGYW) are at increased risk of sexually transmitted infections (STIs). We assessed sexual-risk behaviours and HIV and syphilis prevalence among AGYW in Uganda to ...inform the design of target-specific risk-reduction interventions.
This analysis utilizes data from 8,236 AGYW aged 10-24 years, collected in 20 districts, between July and August 2018. AGYW engaged in sexual-risk behaviour if they: a) reported a history of STIs; or b) had their sexual debut before age 15; or c) engaged in sex with 2+ partners in the past 12 months; or c) did not use or used condoms inconsistently with their most recent partners. We diagnosed HIV using DetermineTM HIV-1/2, Stat-PakTM HIV-1/2 and SD Bioline. We used SD Bioline Syphilis test kits to diagnose syphilis and Treponema Pallidum Hemagglutination Assay for confirmatory syphilis testing. Comparison of proportions was done using Chi-square (χ2) tests. Data were analysed using STATA (version 14.1).
Of 4,488 AGYW (54.5%) that had ever had sex, 12.9% (n = 581) had their sexual debut before age 15; 19.1% (n = 858) reported a history of STIs. Of those that had ever had sex, 79.6% (n = 3,573) had sex in the 12 months preceding the survey; 75.6% (n = 2,707) with one (1) and 24.2% (n = 866) with 2+ partners. Condom use with the most recent sexual partner was low, with only 20.4% (n = 728) reporting consistent condom use while 79.6% (n = 2,842) reported inconsistent or no condom use. In-school AGYW were significantly less likely to have ever had sex (35.6% vs. 73.6%, P<0.001), to have had sexual debut before age 15 (7.7% vs. 15.5%, P<0.001) or to engage in sex with 2+ partners (5.3% vs. 15.8%, P<0.001). Consistent condom use was significantly higher among in-school than out-of-school AGYW (40.1% vs. 12.7%, P<0.001). Overall, 1.7% (n = 143) had HIV while 1.3% (n = 104) had syphilis. HIV and syphilis prevalence was higher among out-of-school than in-school AGYW (HIV: 2.6% vs. 0.9%; syphilis: 2.1% vs. 0.5%, respectively).
In-school AGYW engaged in more protective sexual behaviors and had less HIV and syphilis than their out-of-school counterparts. These findings suggest a need for target-specific risk-reduction interventions stratified by schooling status.
The National Council for Higher Education (NCHE) and the Growth of the University Sub-sector in Uganda, 2002-2012, narrates the experience of the Ugandan NCHE in the establishment, development and ...regulation of higher education institutions in Uganda from 2002 to 2012. In this period, student numbers in higher education institutions increased from about 65,000 to some 200,000 and university institutions from about ten to more than triple the number. The book discusses the role of a regulatory agency in the delivery of higher education, the relations of universities and colleges with such an agency, its impact on developing university capacities, and leadership in creating and refining higher education ideas. The experience of Uganda’s regulatory agency, the NCHE, in those ten years should help both the Ugandan and other African countries’ higher education stakeholders in sharing lessons learned from this one case study. The author sees the roles of regulatory agencies as vital in the initial stages of building a higher education sub-sector and in periods of system transitions such as the current journey from elite to mass systems but is of the view that the university remains the home of knowledge creation, dissemination, and its application in society.
Background: Human immunodeficiency virus (HIV)-infected women are at high risk of cervical cancer.
Objective: This study assessed uptake and correlates of cervical screening among HIV-infected women ...in care in Uganda.
Methods: A nationally representative cross-sectional survey of HIV-infected women in care was conducted from August to November 2016. Structured interviews were conducted with 5198 women aged 15-49 years, from 245 HIV clinics. Knowledge and uptake of cervical screening and human papillomavirus (HPV) vaccination were determined. Correlates of cervical screening were assessed with modified Poisson regression to obtain prevalence ratios (PRs) using Stata version 12.0.
Results: Overall, 94.0% (n = 4858) had ever heard of cervical screening and 66% (n = 3732) knew a screening site. However, 47.4% (n = 2302) did not know the schedule for screening and 50% (n = 2409) did not know the symptoms of cervical cancer. One-third (33.7%; n = 1719) rated their risk of cervical cancer as low. Uptake of screening was 30.3% (n = 1561). Women who had never been screened cited lack of information (29.6%; n = 1059) and no time (25.5%; n = 913) as the main reasons. Increased likelihood of screening was associated with receipt of HIV care at a level II health center adj. PR 1.89, 95% confidence interval (CI) 1.29-2.76 and private facilities (adj. PR 1.68, 95% CI 1.16-3.21), knowledge of cervical screening (adj. PR 2.19, 95% CI 1.78-2.70), where to go for screening (adj. PR 6.47, 95% CI 3.69-11.36), and low perception of risk (adj. PR 1.52, 95% CI 1.14-2.03). HPV vaccination was 2%.
Conclusions: Cervical screening and HPV vaccination uptake were very low among HIV-infected women in care in Uganda. Improved knowledge of cervical screening schedules and sites, and addressing fears and risk perception may increase uptake of cervical screening in this vulnerable population.
Many people living with HIV would like to have children but family planning (FP) services often focus on only contraception. Availability of safer conception services is still very low in most low ...income countries. In this study we assessed the knowledge and use of safer conception methods (SCM) among HIV infected women in HIV care in Uganda to inform integration of safer conception in existing FP services.
Data were accrued from a nationally representative cross-sectional survey of 5198 HIV+ women aged 15-49 years from 245 HIV clinics in Uganda. Knowledge and use of safer conception methods and associated factors were determined. The measure of association was prevalence ratio (PR) with corresponding 95% confidence intervals, obtained using a modified Poisson regression via generalized linear models. All the analyses were conducted using STATA version 12.0.
Overall knowledge of any safer conception method was 74.1% (3852/5198). However only 13.2% knew 3 to 4 methods, 18.9% knew only 2 methods and 42% knew only one method. Knowledge of specific SCM was highest for timed unprotected intercourse (TUI) at 39% (n = 2027) followed by manual self-insemination (MSI) at 34.8% (n = 1809), and pre-exposure prophylaxis (PrEP) at 24.8% (n = 1289). Knowledge of SCM was higher in the Eastern region (84.8%, P < 0.001), among women in HIV-discordant relationships (76.7%, p < 0.017), and those on ART (74.5%, p < 0.034). Overall, 1796 (34.6%) women were pregnant or reported a birth in the past 2 years-overall use of SCM in this group was 11.6% (209/1796). The odds of use of SCM were significantly lower in Kampala adj. PR = 0.489(0.314, 0.764) or Eastern region adj.PR = 0.244; (0.147, 0.405) compared to Northern region. Higher odds of SCM use were associated with HIV status disclosure to partner adj.PR = 2.613(1.308, 5.221) and sero-discordant compared to HIV+ concordant relationship adj.PR = 1.637(1.236, 2.168). Pre-existing knowledge of any one SCM did not influence SCM use.
Knowledge and use of SCM among HIV+ women in care is low. Efforts to improve HIV status disclosure, integration of safer conception into FP and HIV services and regional efforts to promote sensitization and access to safer conception can help to increase uptake of safer conception methods.
On 6 February 2015, Kampala city authorities alerted the Ugandan Ministry of Health of a "strange disease" that killed one person and sickened dozens. We conducted an epidemiologic investigation to ...identify the nature of the disease, mode of transmission, and risk factors to inform timely and effective control measures.
We defined a suspected case as onset of fever (≥37.5 °C) for more than 3 days with abdominal pain, headache, negative malaria test or failed anti-malaria treatment, and at least 2 of the following: diarrhea, nausea or vomiting, constipation, fatigue. A probable case was defined as a suspected case with a positive TUBEX® TF test. A confirmed case had blood culture yielding Salmonella Typhi. We conducted a case-control study to compare exposures of 33 suspected case-patients and 78 controls, and tested water and juice samples.
From 17 February-12 June, we identified 10,230 suspected, 1038 probable, and 51 confirmed cases. Approximately 22.58% (7/31) of case-patients and 2.56% (2/78) of controls drank water sold in small plastic bags (OR
= 8.90; 95%CI = 1.60-49.00); 54.54% (18/33) of case-patients and 19.23% (15/78) of controls consumed locally-made drinks (OR
= 4.60; 95%CI: 1.90-11.00). All isolates were susceptible to ciprofloxacin and ceftriaxone. Water and juice samples exhibited evidence of fecal contamination.
Contaminated water and street-vended beverages were likely vehicles of this outbreak. At our recommendation authorities closed unsafe water sources and supplied safe water to affected areas.
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•Pregnancy-induced rise in fecal progesterone metabolites was detected only by EIA.•11-deoxycortisol was the main fecal glucocorticoid detected by UPC2-MS/MS.•Fecal ...11-ketoandrostenedione was detected by UPC2-MS/MS in males and females.•Bacteroidia was the most abundant fecal microbe class in both sexes.•Spirochaetia abundance was decreased in response to immobilization in a male.
Increased poaching in northern South Africa has necessitated relocation of large numbers of southern white rhinoceros (Ceratotherium simum simum) to the Eastern Cape Province. The climate and grassland ecology of this province differ from that of northern South Africa which may impact the health of this species. This assessment of fecal steroid levels and microbiome in 10 free-ranging southern white rhinoceros in the Eastern Cape will provide insights into white rhinoceros physiology in this biome. Fecal steroid metabolites were analyzed using enzyme immunoassay (EIA) and ultra-performance convergence chromatography tandem mass spectrometry (UPC2-MS/MS). Fecal microbial composition was assessed via next generation sequencing. EIAs with antibodies raised against progesterone (P4; mouse monoclonal – CL425 clone), testosterone (T; rabbit polyclonal), corticosterone (B; sheep polyclonal) were utilized. Pregnant females had large quantities of fecal progesterone metabolites (FPMs) detected by CL425 EIA. Pregnant females also had native P4 and 11α-hydroxydihydroprogesterone (11αOHDHP4; 4-pregnen-11α-ol-3,20-dione) detected by UPC2-MS/MS but these concentrations were 1000-fold less than the concentrations of FPMs detected by the CL425 EIA. By contrast, non-pregnant females had FPM concentrations detected by CL425 EIA which were similar to native P4 and 11αOHDHP4 concentrations detected by UPC2-MS/MS. Mean fecal androgen metabolite (FAM) concentrations detected by the T EIA were similar between males and females. 11-ketoandrostenedione (11KA4) detected by UPC2-MS/MS was higher in females than males. However, there was no difference between males and females in the concentration of fecal glucocorticoid metabolites (FGMs) detected by the B EIA. Bacteroidia, followed by Clostridia, was the most abundant classes of fecal microbes. The unfiltered microbiome of females was more diverse than that of males. The core fecal microbiome of young rhinoceros had a higher observed species richness (Shannon diversity index, and Simpson diversity index) than that of old rhinoceros. In the alpha male, immobilization was associated with an increase in FGMs detected by 11-deoxycortisol (S) detected by UPC2-MS/MS coupled with decreased abundance of Spirochaetia. We detected substantially different FAM and FPM concentrations from those previously reported for both captive and wild white rhinoceros. Comparison of our UPC2-MS/MS and EIA results underscores the fact that most EIAs are highly cross reactive for many steroid metabolites. Our data also demonstrates a distinct effect of stress not only on FGMs but also on the fecal microbiome. This is the first non-invasive assessment of fecal steroid metabolites by UPC2-MS/MS and the fecal microbiome in wild white rhinoceros.