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  1. Paterson RRM
    Environ Sci Pollut Res Int, 2021 May;28(17):21193-21203.
    PMID: 33410008 DOI: 10.1007/s11356-020-12072-5
    Palms are highly significant tropical plants. Oil palms produce palm oil, the basic commodity of a highly important industry. Climate change from greenhouse gasses is likely to decrease the ability of palms to survive, irrespective of them providing ecosystem services to communities. Little information about species survival in tropical regions under climate change is available and data on species migration under climate change is important. Palms are particularly significant in Africa: a palm oil industry already exists with Nigeria being the largest producer. Previous work using CLIMEX modelling indicated that Africa will have reduced suitable climate for oil palm in Africa. The current paper employs this modelling to assess how suitable climate for growing oil palm changed in Africa from current time to 2100. An increasing trend in suitable climate from west to east was observed indicating that refuges could be obtained along the African tropical belt. Most countries had reduced suitable climates but others had increased, with Uganda being particularly high. There may be a case for developing future oil palm plantations towards the east of Africa. The information may be usefully applied to other palms. However, it is crucial that any developments will fully adhere to environmental regulations. Future climate change will have severe consequences to oil palm cultivation but there may be scope for eastwards mitigation in Africa.
    Matched MeSH terms: Uganda
  2. Galadima AN, Zulkefli NAM, Said SM, Ahmad N
    BMC Public Health, 2021 07 28;21(1):1475.
    PMID: 34320942 DOI: 10.1186/s12889-021-11466-5
    BACKGROUND: Vaccine preventable diseases are still the most common cause of childhood mortality, with an estimated 3 million deaths every year, mainly in Africa and Asia. An estimate of 29% deaths among children aged 1-59 months were due to vaccine preventable diseases. Despite the benefits of childhood immunisation, routine vaccination coverage for all recommended Expanded Programme on Immunization vaccines has remained poor in some African countries, such as Nigeria (31%), Ethiopia (43%), Uganda (55%) and Ghana (57%). The aim of this study is to collate evidence on the factors that influence childhood immunisation uptake in Africa, as well as to provide evidence for future researchers in developing, implementing and evaluating intervention among African populations which will improve childhood immunisation uptake.

    METHODS: We conducted a systematic review of articles on the factors influencing under-five childhood immunisation uptake in Africa. This was achieved by using various keywords and searching multiple databases (Medline, PubMed, CINAHL and Psychology & Behavioral Sciences Collection) dating back from inception to 2020.

    RESULTS: Out of 18,708 recorded citations retrieved, 10,396 titles were filtered and 324 titles remained. These 324 abstracts were screened leading to 51 included studies. Statistically significant factors found to influence childhood immunisation uptake were classified into modifiable and non-modifiable factors and were further categorised into different groups based on relevance. The modifiable factors include obstetric factors, maternal knowledge, maternal attitude, self-efficacy and maternal outcome expectation, whereas non-modifiable factors were sociodemographic factors of parent and child, logistic and administration factors.

    CONCLUSION: Different factors were found to influence under-five childhood immunisation uptake among parents in Africa. Immunisation health education intervention among pregnant women, focusing on the significant findings from this systematic review, would hopefully improve childhood immunisation uptake in African countries with poor coverage rates.

    Matched MeSH terms: Uganda
  3. Matsuda I, Ihobe H, Tashiro Y, Yumoto T, Baranga D, Hashimoto C
    Primates, 2020 May;61(3):473-484.
    PMID: 32026152 DOI: 10.1007/s10329-020-00794-6
    One of the goals for primate feeding ecology is to understand the factors that affect inter- and intra-specific variations. Therefore, a detailed description of basic feeding ecology in as many populations as possible is necessary and warrants further understanding. The black-and-white colobus (Colobus guereza) or guereza is widely distributed in Africa and is one of the well-studied colobines in terms of their feeding; they demonstrate considerable variation in their diets in response to local conditions. We studied the diet of a group of guerezas in the Kalinzu Forest, Uganda, for over 30 consecutive months using behavioral observation (4308 h in total), phenology, and vegetation surveys. A total of 31 plant species were consumed by the study group. This study group was predominantly folivorous; the majority of their feeding time was involved in feeding on young leaves (87%). However, during certain times of the year, fruits and seeds accounted for 45% of monthly feeding time. Young leaves of Celtis durandii were by far the most important food, which constituted 58% of the total feeding records. There was a significant increase in the consumption of fruits and flowers once young leaf availability was low, but their consumption of fruits did not significantly increase even when fruit availability was high. Their monthly dietary diversity increased as the number of available plants with young leaves declined, suggesting that much of the dietary diversity in the study group may be attributable to the young leaf portion of their diet. Our findings may help contribute to a better understanding of the dietary adaptations and feeding ecology of guerezas in response to local environmental conditions.
    Matched MeSH terms: Uganda
  4. Mueller W, Jones K, Fuhrimann S, Ahmad ZNBS, Sams C, Harding AH, et al.
    Environ Res, 2024 Feb 01;242:117651.
    PMID: 37996007 DOI: 10.1016/j.envres.2023.117651
    BACKGROUND: Long-term exposure to pesticides is often assessed using semi-quantitative models. To improve these models, a better understanding of how occupational factors determine exposure (e.g., as estimated by biomonitoring) would be valuable.

    METHODS: Urine samples were collected from pesticide applicators in Malaysia, Uganda, and the UK during mixing/application days (and also during non-application days in Uganda). Samples were collected pre- and post-activity on the same day and analysed for biomarkers of active ingredients (AIs), including synthetic pyrethroids (via the metabolite 3-phenoxybenzoic acid [3-PBA]) and glyphosate, as well as creatinine. We performed multilevel Tobit regression models for each study to assess the relationship between exposure modifying factors (e.g., mixing/application of AI, duration of activity, personal protective equipment [PPE]) and urinary biomarkers of exposure.

    RESULTS: From the Malaysia, Uganda, and UK studies, 81, 84, and 106 study participants provided 162, 384 and 212 urine samples, respectively. Pyrethroid use on the sampling day was most common in Malaysia (n = 38; 47%), and glyphosate use was most prevalent in the UK (n = 93; 88%). Median pre- and post-activity 3-PBA concentrations were similar, with higher median concentrations post-compared to pre-activity for glyphosate samples in the UK (1.7 to 0.5 μg/L) and Uganda (7.6 to 0.8 μg/L) (glyphosate was not used in the Malaysia study). There was evidence from individual studies that higher urinary biomarker concentrations were associated with mixing/application of the AI on the day of urine sampling, longer duration of mixing/application, lower PPE protection, and less education/literacy, but no factor was consistently associated with exposure across biomarkers in the three studies.

    CONCLUSIONS: Our results suggest a need for AI-specific interpretation of exposure modifying factors as the relevance of exposure routes, levels of detection, and farming systems/practices may be very context and AI-specific.

    Matched MeSH terms: Uganda
  5. Nti J, Afagbedzi S, da-Costa Vroom FB, Ibrahim NA, Guure C
    Biomed Res Int, 2021;2021:9957160.
    PMID: 34395630 DOI: 10.1155/2021/9957160
    Background: The Ghana Demographic and Health Survey 2014 report indicates that anemia among women in their reproductive age in the country stood at 42 percent, making it a severe public health problem according to the World Health Organization (WHO) classification. WHO Global Observatory data indicates that some sub-Saharan African countries have been able to reduce the prevalence of anemia among women of reproductive age compared to Ghana in 2016. To inform policy decisions, data from the Demographic and Health Surveys 2014-2018 were analyzed to determine the disparities in the prevalence of anemia and related factors among women of reproductive age in Ghana, Ethiopia, Uganda, Tanzania, and Rwanda.

    Methods: This research utilized data from the Demographic and Health Surveys 2014, 2016, 2014-2015, 2015-2016, and 2016 from Ghana, Ethiopia, Rwanda, Tanzania, and Uganda, respectively. Respondents were women aged between 15 and 49 years. Hemoglobin levels were measured by HemoCue hemoglobin meter. 45,299 women data were extracted from the five countries with 4,644, 14,923, 6,680, 13,064, and 5,988 from Ghana, Ethiopia, Rwanda, Tanzania, and Uganda, respectively. Association between anemia and selected predictive variables was assessed using Pearson's chi-square test statistic. Poisson regression with robust standard errors was used to estimate the prevalence rate ratios of developing anemia. The deviance goodness of fit test was employed to test the fit of the Poisson model to the data set.

    Results: There was a statistically significant difference in prevalence of 1,962 (42.3%), 3,527 (23.6%), 1,284 (19.3%), 5,857 (44.8%), and 1,898 (31.7%) for Ghana, Ethiopia, Rwanda, Tanzania, and Uganda, respectively, χ 2 = 2,181.86 and p value < 0.001. Parity, pregnancy status, and contraceptives significantly increased the prevalence rate ratio of a woman developing anemia. Women in Ethiopia with a parity of six or more were 58% more likely to develop anemia than those with parity of zero. Tanzanian women who were pregnant had a 14% increased rate ratio of developing anemia. Factors that significantly decreased anemia in this study were wealth index, women's age, and women's highest level of education. Women who were in the higher education category in Ethiopia were 57% less likely to develop anemia. Ugandan women in the richest category of the wealth index were 28% less likely to develop anemia. Rwandan women in the middle category of the wealth index were 20% less likely to develop anemia. Women who were within the 45-49 age category in Ethiopia were 48% less likely to develop anemia.

    Conclusion: The individual country governments should encourage the implementation of increasing female enrollment in higher education. Women in their reproductive age should be encouraged to use modern contraceptives to reduce their anemia prevalence.

    Matched MeSH terms: Uganda/epidemiology
  6. Waters MFR, Stanford JL
    Int. J. Lepr. Other Mycobact. Dis., 1985 Dec;53(4):546-53.
    PMID: 4086918
    A detailed account and definition is given of the previously inadequately described "giant reactions" to tuberculin occasionally seen in leprosy patients. The reaction is an accelerated and exaggerated response to species-specific antigens of Mycobacterium tuberculosis found in both PPD and New tuberculin. Our studies were performed in Malaysia, Uganda, Spain, and England. There was a significantly higher incidence of the phenomenon in Malaysia than in the other centers, but this may have been because there alone previously untreated lepromatous (LL and BL) patients were serially tested for up to three years after starting chemotherapy. Of the 28 patients exhibiting giant reactions, 27 occurred among lepromatous patients (24 LL and 3 BL), of which only 3 (1 LL and 2 BL) were untreated. One treated BL patient had developed, and one untreated BL patient was a family contact of, active tuberculosis. Giant reactions are uncommon in untreated and in very long-term treated LL patients, but may occur in up to a fifth of those receiving their first 1-3 years of chemotherapy. Although the mechanism is not yet understood, it appears to be a coincidence of delayed hypersensitivity of the tuberculin type and a less-delayed phenomenon of excessive local edema associated with local lymphadenopathy and short-lasting symptoms of malaise and pyrexia. It is suggested that the majority of giant reactions occur during a period of temporary lack of immune regulation associated with changing levels of antigenic load.
    Matched MeSH terms: Uganda
  7. Mwungu CM, Shikuku KM, Atibo C, Mwongera C
    Data Brief, 2019 Apr;23:103818.
    PMID: 31372462 DOI: 10.1016/j.dib.2019.103818
    Climate change, degradation of natural resources, conflict or civil war, diseases and poverty are among the key threats that impact agriculture, human nutrition, food security and food safety among rural households in developing countries. Sustainability of food systems and livelihoods will thus crucially depend on not only the ability to accommodate or recover from these threats but also to tap into opportunities for strengthening long-term capabilities. One approach to enhancing resilience to enhance food security and nutrition is building an evidence base to better understand the various types of smallholders, threats to agriculture production and the associated risks to food security and nutrition and household food preferences. Unfortunately, such data in many African countries is still unavailable or has not been shared publicly. In this paper, we describe data that were collected in Nwoya district, Northern Uganda in December 2017. These data can be used to assess the relationship between resilience of farm households to climatic risks and their food and nutrition security.
    Matched MeSH terms: Uganda
  8. Yun SI, Song BH, Frank JC, Julander JG, Polejaeva IA, Davies CJ, et al.
    Genome Announc, 2016;4(4).
    PMID: 27540058 DOI: 10.1128/genomeA.00800-16
    Here, we report the 10,807-nucleotide-long consensus RNA genome sequences of three spatiotemporally distinct and genetically divergent Zika virus strains, with the functionality of their genomic sequences substantiated by reverse genetics: MR-766 (African lineage, Uganda, 1947), P6-740 (Asian lineage, Malaysia, 1966), and PRVABC-59 (Asian lineage-derived American strain, Puerto Rico, 2015).
    Matched MeSH terms: Uganda
  9. Sorketti, E.A., Habil, M.H.
    MyJurnal
    The Sudan occupies area of land in East Africa, almost one million square miles, or 2.5 million squares km2. It shares boundaries with nine countries: two of which are Arab, Egypt, Libya, Kenya, Uganda, The Congo, Chad, The Republic of Central Africa, Ethiopia and Eritrea. The country is situated in a strategic important geographical location that links the Arab world to Sub Saharan Africa, where the Sudanese population and those of the neighboring countries move freely across most of these borders .Sudan geography, climate, and multi-ethnic and cultural backgrounds remain the major health determinant. Sudan is the largest country in Africa. The heart of the country, in terms of population, lies at the confluence of the Blue and White Niles. The complex of the "three towns," comprising the three largest cities, Khartoum, Khartoum North and Omdurman, is situated there and contains almost 20% of the population. The total population of Sudan was about 39.39 million (projected from 2009 census). the urban population was estimated at 33%. About 2.2 million are still entirely nomadic. Sudan’s peoples are as diverse as its geography. There are about 19 major ethnic groups and a further 597 subgroups. Sudan is rich in terms of natural and human resources, but economic and social development have been below the expectation.
    Matched MeSH terms: Uganda
  10. Nabukeera, M., Boerhannoeddin, A., Raja Noriza, R.A.
    JUMMEC, 2015;18(1):1-6.
    MyJurnal
    The Pabon Lasso Model is one of the most important and suitable techniques applied in evaluating the performance of hospitals. The visual representation standardizes the comparative accomplishments of hospitals which information is used by planners in effort to improve productivity of the health care system by use of three pointers namely: (i) Average Length of Stay (ALS); (ii) Bed Occupancy Rate (BOR); (iii) Bed Turnover (BTO). The purpose of this study is to evaluate performance of wards in health centers affiliated to Kampala Capital City Authority (KCCA) and Ministry of Health (MOH) during the financial year 2012-2013 constructed on Pabon Lasso Model. Data for the nine health centers and two referral hospitals was taken by the nursing sisters who were in charge. To ensure accuracy, a weekly standard report was submitted to head office and the data included: a list of wards, number of beds, admissions, deaths, discharges and inpatient days. For all government health centers and hospitals, overall, the average indicators ALS=3.63 days, BTO= 74.0 times per year and BOR=49.3% were obtained. Based on the Pabon Lasso graph, two wards are in Zone 3, two wards in Zone 4, one ward in Zone 2 and five wards in Zone 1. The performance of health centers and hospitals in Kampala were somehow poor. This represented unacceptable levels of technical deficiency.
    Matched MeSH terms: Uganda
  11. Nabukeera, M., Boerhannoeddin, A., Raja Noriza, R.A.
    JUMMEC, 2017;20(1):6-14.
    MyJurnal
    The study aimed to assess whether sharing of health services improved service quality in health centers in Kampala Capital City Authority (KCCA). With multi-stage sampling, data was gathered by face to face interviews, via translators from residents in the five divisions of KCCA, using a questionnaire. Schedules were made with Local Council I chairmen, and support to fill in the questionnaire was given to the respondents. The statistical methods used for analysis included a Chi-square, Spearman correlations and hierarchical regression. The study found that regarding tangibility, sharing health services significantly determines the number of modern medical equipments (p=0.000) and the number of medical personnel that had a neat and professional appearance (p=0.000) but did not determine the number of visually appealing health facilities (p=0.386). Recentralizing health care changed the mode of delivery. Health workers were responsive, reliable and provide better care for patients. There was increased availability of basic medical equipment, and health workers were neater in appearance with increased confidence and hence were better able to provide for the safety of residents.
    Study site: clinic, Kampala, Uganda
    Matched MeSH terms: Uganda
  12. Tham HW, Balasubramaniam V, Ooi MK, Chew MF
    Front Microbiol, 2018;9:1040.
    PMID: 29875751 DOI: 10.3389/fmicb.2018.01040
    Zika virus (ZIKV) has emerged as a new global health threat. Since its first discovery in Zika forest in Uganda, this virus has been isolated from several mosquito species, including Aedes aegypti and Aedes albopictus. The geographical distribution of these mosquito species across tropical and subtropical regions has led to several outbreaks, including the recent pandemic in Brazil, followed by the Pacific islands and other areas of North and South America. This has gained attention of the scientific community to elucidate the epidemiology and transmission of ZIKV. Despite its strong attention on clinical aspects for healthcare professionals, the relationships between ZIKV and its principal vectors, A. aegypti and A. albopictus, have not gained substantial interest in the scientific research community. As such, this review aims to summarize the current knowledge on ZIKV tropism and some important mechanisms which may be employed by the virus for effective strategies on viral survival in mosquitoes. In addition, this review identifies the areas of research that should be placed attention to, for which to be exploited for novel mosquito control strategies.
    Matched MeSH terms: Uganda
  13. Nur Alyana, B.A., Sahdi, H., Rasit, A.H., Zabidah, P.
    JUMMEC, 2018;21(2):15-22.
    MyJurnal
    congenital deformity among paediatric patients. The outcome of starting clubfoot treatment early is very
    promising. Patient retention throughout the treatment programme is challenging in Sarawak. In this study,
    we explored the barriers that parents/caregivers face when seeking clubfoot treatment in Sarawak, Northwest
    Borneo. A better understanding of the barriers will provide us with the information to formulate effective
    programmes for clubfoot treatment in this region.
    Methods: We conducted a questionnaire-based quantitative cross-sectional descriptive survey. We adapted
    a set of closed-ended questionnaires originally designed by Kazibwe and Struthers in a study done in Uganda
    in the year 2006.
    Results: A total of 53 parents/caregivers of children with idiopathic clubfoot were recruited in this study, with
    16 defaulter cases and 37 non-defaulter cases. We found 2 statistically significant barriers to clubfoot treatment
    in Sarawak, with p-value < 0.05, namely the geographical factor (p = 0.019) and logistic factor (p = 0.017).
    Conclusion: Barriers to clubfoot treatment that influence the compliance to treatment identified in this study
    are long distance travel, logistics limitations, uncooperative patients during treatment, parents/caregivers
    having other commitments, unsupportive family members, lack of understanding regarding clubfoot and its
    treatment, inadequate specialists in clubfoot, traditional socio-cultural beliefs and practices and economic
    constraints. Enhanced understanding in this matter will guide us in devising culturally admissible ways to
    increase awareness in parents/caregivers regarding clubfoot and its treatment. A sustainable national clubfoot
    program will be very beneficial in providing a holistic approach to tackle barriers to treatment in our country.
    Matched MeSH terms: Uganda
  14. Arnold JD, Balcerzak SP, Martin DC
    Mil Med, 1969 Sep;134(10):962-71.
    PMID: 4987072
    Matched MeSH terms: Uganda
  15. Nabuuma D, Ekesa B, Faber M, Mbhenyane X
    Food Nutr Bull, 2024 Mar;45(1):24-37.
    PMID: 38661354 DOI: 10.1177/03795721241240854
    BACKGROUND: Food-based strategies have a high potential of improving the diet quality and reducing the prevalence of nutrient deficiencies in agriculture-dependent communities. Their design is however complex with trade-offs that are rarely systematically presented to allow replication and efficient contextualization.

    OBJECTIVE: The systematic design of a food-based strategy to improve the dietary diversity of children in rural farming communities in Uganda.

    METHODS: The intervention mapping protocol was used to provide a systematic approach to developing theory-based and evidence-based intervention methods and strategy.

    RESULTS: The priority behavioral and environmental determinants identified were related to food production, consumption, and efficacy while the personal determinants focused on knowledge, skills, self-efficacy, attitude, and outcome expectations. The aim of the resulting strategy was set to improve the availability, accessibility, and consumption of diverse foods, with a particular focus on production diversity, production practices, market access, and market diversity. Behaviour change methods were selected to enhance ability and self-efficacy, strategic goal setting, and provision of feedback. The strategy focused on household groups for learning, demonstration, practice, and social support. The validation showed that the determinants and actors incorporated in the strategy were important and relevant for improving the productivity, food availability, dietary diversity, livelihoods, and health of rural farming households and communities.

    CONCLUSION: Application of the protocol yielded a contextualized food-based strategy that can be adjusted for use in other smallholder contexts in developing countries by piloting implementation plans based on the strategy; reassessing the key determinants and implementing the revised strategy; or replicating the whole design process.

    Matched MeSH terms: Uganda
  16. Atherstone C, Diederich S, Weingartl HM, Fischer K, Balkema-Buschmann A, Grace D, et al.
    Transbound Emerg Dis, 2019 Mar;66(2):921-928.
    PMID: 30576076 DOI: 10.1111/tbed.13105
    Hendra virus (HeV) and Nipah virus (NiV), belonging to the genus Henipavirus, are among the most pathogenic of viruses in humans. Old World fruit bats (family Pteropodidae) are the natural reservoir hosts. Molecular and serological studies found evidence of henipavirus infection in fruit bats from several African countries. However, little is known about the potential for spillover into domestic animals in East Africa, particularly pigs, which served as amplifying hosts during the first outbreak of NiV in Malaysia and Singapore. We collected sera from 661 pigs presented for slaughter in Uganda between December 2015 and October 2016. Using HeV G and NiV G indirect ELISAs, 14 pigs (2%) were seroreactive in at least one ELISA. Seroprevalence increased to 5.4% in October 2016, when pigs were 9.5 times more likely to be seroreactive than pigs sampled in December 2015 (p = 0.04). Eight of the 14 ELISA-positive samples reacted with HeV N antigen in Western blot. None of the sera neutralized HeV or NiV in plaque reduction neutralization tests. Although we did not detect neutralizing antibodies, our results suggest that pigs in Uganda are exposed to henipaviruses or henipa-like viruses. Pigs in this study were sourced from many farms throughout Uganda, suggesting multiple (albeit rare) introductions of henipaviruses into the pig population. We postulate that given the widespread distribution of Old World fruit bats in Africa, spillover of henipaviruses from fruit bats to pigs in Uganda could result in exposure of pigs at multiple locations. A higher risk of a spillover event at the end of the dry season might be explained by higher densities of bats and contact with pigs at this time of the year, exacerbated by nutritional stress in bat populations and their reproductive cycle. Future studies should prioritize determining the risk of spillover of henipaviruses from pigs to people, so that potential risks can be mitigated.
    Matched MeSH terms: Uganda/epidemiology
  17. Walker PJ, Widen SG, Firth C, Blasdell KR, Wood TG, Travassos da Rosa AP, et al.
    Am J Trop Med Hyg, 2015 Nov;93(5):1041-51.
    PMID: 26324724 DOI: 10.4269/ajtmh.15-0344
    The genus Nairovirus of arthropod-borne bunyaviruses includes the important emerging human pathogen, Crimean-Congo hemorrhagic fever virus (CCHFV), as well as Nairobi sheep disease virus and many other poorly described viruses isolated from mammals, birds, and ticks. Here, we report genome sequence analysis of six nairoviruses: Thiafora virus (TFAV) that was isolated from a shrew in Senegal; Yogue (YOGV), Kasokero (KKOV), and Gossas (GOSV) viruses isolated from bats in Senegal and Uganda; Issyk-Kul virus (IKV) isolated from bats in Kyrgyzstan; and Keterah virus (KTRV) isolated from ticks infesting a bat in Malaysia. The S, M, and L genome segments of each virus were found to encode proteins corresponding to the nucleoprotein, polyglycoprotein, and polymerase protein of CCHFV. However, as observed in Leopards Hill virus (LPHV) and Erve virus (ERVV), polyglycoproteins encoded in the M segment lack sequences encoding the double-membrane-spanning CCHFV NSm protein. Amino acid sequence identities, complement-fixation tests, and phylogenetic analysis indicated that these viruses cluster into three groups comprising KKOV, YOGV, and LPHV from bats of the suborder Yingochiroptera; KTRV, IKV, and GOSV from bats of the suborder Yangochiroptera; and TFAV and ERVV from shrews (Soricomorpha: Soricidae). This reflects clade-specific host and vector associations that extend across the genus.
    Matched MeSH terms: Uganda/epidemiology
  18. Mousa A, Al-Taiar A, Anstey NM, Badaut C, Barber BE, Bassat Q, et al.
    PLoS Med, 2020 10;17(10):e1003359.
    PMID: 33075101 DOI: 10.1371/journal.pmed.1003359
    BACKGROUND: Delay in receiving treatment for uncomplicated malaria (UM) is often reported to increase the risk of developing severe malaria (SM), but access to treatment remains low in most high-burden areas. Understanding the contribution of treatment delay on progression to severe disease is critical to determine how quickly patients need to receive treatment and to quantify the impact of widely implemented treatment interventions, such as 'test-and-treat' policies administered by community health workers (CHWs). We conducted a pooled individual-participant meta-analysis to estimate the association between treatment delay and presenting with SM.

    METHODS AND FINDINGS: A search using Ovid MEDLINE and Embase was initially conducted to identify studies on severe Plasmodium falciparum malaria that included information on treatment delay, such as fever duration (inception to 22nd September 2017). Studies identified included 5 case-control and 8 other observational clinical studies of SM and UM cases. Risk of bias was assessed using the Newcastle-Ottawa scale, and all studies were ranked as 'Good', scoring ≥7/10. Individual-patient data (IPD) were pooled from 13 studies of 3,989 (94.1% aged <15 years) SM patients and 5,780 (79.6% aged <15 years) UM cases in Benin, Malaysia, Mozambique, Tanzania, The Gambia, Uganda, Yemen, and Zambia. Definitions of SM were standardised across studies to compare treatment delay in patients with UM and different SM phenotypes using age-adjusted mixed-effects regression. The odds of any SM phenotype were significantly higher in children with longer delays between initial symptoms and arrival at the health facility (odds ratio [OR] = 1.33, 95% CI: 1.07-1.64 for a delay of >24 hours versus ≤24 hours; p = 0.009). Reported illness duration was a strong predictor of presenting with severe malarial anaemia (SMA) in children, with an OR of 2.79 (95% CI:1.92-4.06; p < 0.001) for a delay of 2-3 days and 5.46 (95% CI: 3.49-8.53; p < 0.001) for a delay of >7 days, compared with receiving treatment within 24 hours from symptom onset. We estimate that 42.8% of childhood SMA cases and 48.5% of adult SMA cases in the study areas would have been averted if all individuals were able to access treatment within the first day of symptom onset, if the association is fully causal. In studies specifically recording onset of nonsevere symptoms, long treatment delay was moderately associated with other SM phenotypes (OR [95% CI] >3 to ≤4 days versus ≤24 hours: cerebral malaria [CM] = 2.42 [1.24-4.72], p = 0.01; respiratory distress syndrome [RDS] = 4.09 [1.70-9.82], p = 0.002). In addition to unmeasured confounding, which is commonly present in observational studies, a key limitation is that many severe cases and deaths occur outside healthcare facilities in endemic countries, where the effect of delayed or no treatment is difficult to quantify.

    CONCLUSIONS: Our results quantify the relationship between rapid access to treatment and reduced risk of severe disease, which was particularly strong for SMA. There was some evidence to suggest that progression to other severe phenotypes may also be prevented by prompt treatment, though the association was not as strong, which may be explained by potential selection bias, sample size issues, or a difference in underlying pathology. These findings may help assess the impact of interventions that improve access to treatment.

    Matched MeSH terms: Uganda/epidemiology
  19. Baguma D, Hashim JH, Aljunid SM, Loiskandl W
    Sci Total Environ, 2013 Jan 1;442:96-102.
    PMID: 23178827 DOI: 10.1016/j.scitotenv.2012.10.004
    The need for water continues to become more acute with the changing requirements of an expanding world population. Using a logistical analysis of data from 301 respondents from households that harvest rainwater in Uganda, the relationship between dependent variables, such as water management performed as female-dominated practices, and independent variables, such as years of water harvesting, family size, tank operation and maintenance, and the presence of local associations, was investigated. The number of years of water harvesting, family size, tank operation and maintenance, and presence of local associations were statistically significantly related to adequate efficient water management. The number of years of water harvesting was linked to women's participation in household chores more than to the participation of men, the way of livelihoods lived for many years. Large families were concurrent with a reduction in water shortages, partially because of the availability of active labour. The findings also reveal important information regarding water-related operations and maintenance at the household level and the presence of local associations that could contribute some of the information necessary to minimise water-related health risks. Overall, this investigation revealed important observations about the water management carried out by women with respect to underlying safe-water shortages, gender perspectives, and related challenges in Uganda that can be of great importance to developing countries.
    Matched MeSH terms: Uganda
  20. Barrett JP, Behrens RH
    J Travel Med, 1996 Mar 01;3(1):60-61.
    PMID: 9815425
    Chloroquine-resistant Plasmodium vivax was originally reported in Papua, New Guinea by Reickman in 1989.1 In the same year, in Colombia, South America, Arias and Corredor2 reported relapses of 11 patients suffering from vivax malaria, following a chloroquine-primaquine regimen. Garavelli and Corti3 suggested chloroquine-resistant Plasmodium vivax may be present in Brazil following these therapeutic relapses. Further therapeutic failures in returned travelers from South America were reported by Moore et al (1994).4 We report vivax malaria in a group of expeditioners visiting Guyana who, whereas compliant with antimalarial chemoprophylaxis, developed clinical malaria, adding evidence to the presence of chloroquine-resistant Plasmodium vivax in South America. Raleigh International is a youth development charity that undertakes environmental and community projects around the world. These are usually in remote locations. Nine expeditions in countries such as Chile, Belize, Zimbabwe, Uganda, and Malaysia are organized annually. A project manager and a medical officer are placed at each site, along with approximately 10 venturers (age 17-25.) Participants are of all nationalities, but, at present, they are predominantly British.
    Matched MeSH terms: Uganda
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