The reference range of serum magnesium substance concentration among healthy young adults at Makerere University College of Health Sciences 2012

Background: Magnesium is the second most abundant intracellular cation, with only a small proportion of the body’s content being in the extracellular fluid. It is required for the active transport of other cations such as calcium, sodium and potassium across the membrane by active transport system. It is also needed for many intracellular metabolic pathways. This study was carried to establish the reference intervals for serum magnesium substance concentration among healthy medical students in Uganda.Methods: This was purposive study in which ante-cubital venous blood samples were drawn without stasis from 60 healthy, natively Ugandan pre-clinical medical students and analysed without delay using Cobasintegra 400/700/800 automated analyser which flagged each result using the in-built seemingly temperate reference range of 0.65-1.05 mmol/L.Results: The distribution of serum magnesium substance concentration was unimodal, leptokurtic, and positively skewed with empirical range of 0.86 – 1.32 mmol/L. There was no result flagged as low. Twenty-six out of sixty (43.3%) results were flagged as high values while none approached 2.0 mmol/L, considered the threshold of hypermagnesaemia symptoms. Using the central 95 percentile, the reference range was set as 0.81 – 1.29 mmol/L which is higher and slightly broader than the 0.65 – 1.05 mmol/L often quoted for populations in temperate regions and in-built in automated analysers exported even to the tropics.Conclusion: Reference ranges were higher in the studied healthy young adults in Uganda than those in the temperate regions. Effort should therefore be made to enable our laboratories establish their own reference values

Solubility tests and the peripheral blood film method for screening for sickle cell disease: A cost benefit analysis

Objective. To determine the cost benefit of screening for sickle-cell disease among infants at district health centres in Uganda using sickling, solubility tests and the peripheral blood film method. Methods. Pilot screening services were established at district health centres. Cost benefit analysis (CBA) was performed in four scenarios: A1 – where there are no sickle-cell screening services at district health centres and all children are referred either to Mulago tertiary referral hospital or A2 – a regional hospital for haemoglobin (Hb) electrophoresis; B1 – when there are screening services at district health centres, only positive samples are taken either to Mulago Hospital or B2 – the regional hospital for confirmation using haemoglobin electrophoresis. Calculations were done in Uganda shillings (USh). Results. Initial operational costs were high for all scenarios but variably reduced in the subsequent years. Scenarios A1 and A2 were very sensitive compared with B1 and B2. Scenario A1 had the highest screening costs in the subsequent years, costing over 62 000 USh per test in both eastern and western Uganda. Scenario B2 was sensitive and cheaper when using the sickling test, but was expensive and insensitive when using the solubility test and more insensitive though cheaper when using the peripheral blood film method. Conclusions and recommendation. Screening children in Mulago hospital using haemoglobin electrophoresis (A1) was very expensive although it was sensitive. Screening the children at four health centres using the sickling method and confirming positive samples at a regional hospital (B2) was both cheap and sensitive and is therefore recommended

Quantitative Assessment of the Sensitivity of Various Commercial Reverse Transcriptases Based on Armored HIV RNA

The in-vitro reverse transcription of RNA to its complementary DNA, catalyzed by the enzyme reverse transcriptase, is the most fundamental step in the quantitative RNA detection in genomic studies. As such, this step should be as analytically sensitive, efficient and reproducible as possible, especially when dealing with degraded or low copy RNA samples. While there are many reverse transcriptases in the market, all claiming to be highly sensitive, there is need for a systematic independent comparison of their applicability in quantification of rare RNA transcripts or low copy RNA, such as those obtained from archival tissues.We performed RT-qPCR to assess the sensitivity and reproducibility of 11 commercially available reverse transcriptases in cDNA synthesis from low copy number RNA levels. As target RNA, we used a serially known number of Armored HIV RNA molecules, and observed that 9 enzymes we tested were consistently sensitive to ∼1,000 copies, seven of which were sensitive to ∼100 copies, while only 5 were sensitive to ∼10 RNA template copies across all replicates tested. Despite their demonstrated sensitivity, these five best performing enzymes (Accuscript, HIV-RT, M-MLV, Superscript III and Thermoscript) showed considerable variation in their reproducibility as well as their overall amplification efficiency. Accuscript and Superscript III were the most sensitive and consistent within runs, with Accuscript and Superscript II ranking as the most reproducible enzymes between assays.We therefore recommend the use of Accuscript or Superscript III when dealing with low copy number RNA levels, and suggest purification of the RT reactions prior to downstream applications (eg qPCR) to augment detection. Although the results presented in this study were based on a viral RNA surrogate, and applied to nucleic acid lysates derived from archival formalin-fixed paraffin embedded tissue, their relative performance on RNA obtained from other tissue types may vary, and needs future evaluation

Uganda's experience in Ebola virus disease outbreak preparedness, 2018-2019.

BACKGROUND: Since the declaration of the 10th Ebola Virus Disease (EVD) outbreak in DRC on 1st Aug 2018, several neighboring countries have been developing and implementing preparedness efforts to prevent EVD cross-border transmission to enable timely detection, investigation, and response in the event of a confirmed EVD outbreak in the country. We describe Uganda's experience in EVD preparedness. RESULTS: On 4 August 2018, the Uganda Ministry of Health (MoH) activated the Public Health Emergency Operations Centre (PHEOC) and the National Task Force (NTF) for public health emergencies to plan, guide, and coordinate EVD preparedness in the country. The NTF selected an Incident Management Team (IMT), constituting a National Rapid Response Team (NRRT) that supported activation of the District Task Forces (DTFs) and District Rapid Response Teams (DRRTs) that jointly assessed levels of preparedness in 30 designated high-risk districts representing category 1 (20 districts) and category 2 (10 districts). The MoH, with technical guidance from the World Health Organisation (WHO), led EVD preparedness activities and worked together with other ministries and partner organisations to enhance community-based surveillance systems, develop and disseminate risk communication messages, engage communities, reinforce EVD screening and infection prevention measures at Points of Entry (PoEs) and in high-risk health facilities, construct and equip EVD isolation and treatment units, and establish coordination and procurement mechanisms. CONCLUSION: As of 31 May 2019, there was no confirmed case of EVD as Uganda has continued to make significant and verifiable progress in EVD preparedness. There is a need to sustain these efforts, not only in EVD preparedness but also across the entire spectrum of a multi-hazard framework. These efforts strengthen country capacity and compel the country to avail resources for preparedness and management of incidents at the source while effectively cutting costs of using a "fire-fighting" approach during public health emergencies

Role of the health system in influencing uptake of human papillomavirus vaccine among adolescent girls in Mbale District, eastern Uganda: a cross-sectional, mixed-methods study

Background: Cervical cancer ranks as the most common cancer among women in Uganda, and prevalence has increased by 1·8% per annum over the past 20 years. Human papillomavirus (HPV) is responsible for more than 90% of cases of cervical cancer. The availability of an HPV vaccine presents an opportunity to prevent cervical cancer; however, national coverage stands at 17% against target coverage of 80% since the vaccine's introduction in 2015. This study assessed the role of the health system in influencing uptake of the HPV vaccine so as to inform vaccine implementation in Uganda. Methods: We did a cross-sectional study that employed qualitative and quantitative methods. We did structured interviews among 407 adolescents aged 9–15 years systematically selected using Bennet's cluster survey method from five subcounties in Mbale district and six key informants (district health officials) in May 2017. Adolescents were involved in decision making about where to receive the vaccine. We used the WHO six building blocks framework to assess health system factors. Nine health facilities were assessed using a WHO checklist for vaccine service delivery. Quantitative data were analysed using Stata version 13. Qualitative data were analysed using MAXQDA version 12. Uptake was defined as receiving two doses of the vaccine. Findings: 56 (14%) of 407 adolescents self-reported vaccine uptake. 182 (52·3%) of 348 reported lack of awareness about the HPV vaccine as the major reason for not having received it. Receiving vaccines from outreach clinics (p=0·02), having many options from which to receive the vaccine (p=0·002), getting an explanation on possible side-effects (p=0·024), and receiving the vaccine alongside other services (p=0·024) were positively associated with uptake. Key informants reported inconsistency in vaccine supply, inadequate training on HPV vaccine, and the lack of a clear target for HPV vaccine coverage as the health system factors that contribute to low uptake. Interpretation: Uptake was well below the Ministry of Health target of 80%. We recommend training of health workers to provide adequate information on HPV vaccine, raising awareness of the vaccine in markets, schools, and radio talk shows, and communicating the target to health workers. Funding: None

Knowledge, Attitude, and Beliefs of Communities and Health Staff about Echinococcus granulosus Infection in Selected Pastoral and Agropastoral Regions of Uganda

A descriptive cross-sectional survey was done to determine knowledge, attitudes, and beliefs of the communities and health workers about cystic echinococcosis (CE) in pastoral region of Northeastern (NE) and agropastoral regions of Eastern (E) and Central (C) Uganda. Overall a total of 1310 participants were interviewed. Community respondents from NE region were more aware of CE infection than those from Eastern (OR 4.85; CI: 3.60–6.60; p0.05). 51.7% of the community respondents from Central believed CE is caused by witchcraft, compared with 31.3% and 14.3% from NE and EA regions, respectively (p0.05). None of the participants knew his/her CE status. The communities need to be sensitized about CE detection, control, and management and health staff need to be trained on CE diagnosis

Implementation of provider-based electronic medical records and improvement of the quality of data in a large HIV program in Sub-Saharan Africa.

INTRODUCTION: Starting in June 2010 the Infectious Diseases Institute (IDI) clinic (a large urban HIV out-patient facility) switched to provider-based Electronic Medical Records (EMR) from paper EMR entered in the database by data-entry clerks. Standardized clinics forms were eliminated but providers still fill free text clinical notes in physical patients' files. The objective of this study was to compare the rate of errors in the database before and after the introduction of the provider-based EMR. METHODS AND FINDINGS: Data in the database pre and post provider-based EMR was compared with the information in the patients' files and classified as correct, incorrect, and missing. We calculated the proportion of incorrect, missing and total error for key variables (toxicities, opportunistic infections, reasons for treatment change and interruption). Proportions of total errors were compared using chi-square test. A survey of the users of the EMR was also conducted. We compared data from 2,382 visits (from 100 individuals) of a retrospective validation conducted in 2007 with 34,957 visits (from 10,920 individuals) of a prospective validation conducted in April-August 2011. The total proportion of errors decreased from 66.5% in 2007 to 2.1% in 2011 for opportunistic infections, from 51.9% to 3.5% for ART toxicity, from 82.8% to 12.5% for reasons for ART interruption and from 94.1% to 0.9% for reasons for ART switch (all P<0.0001). The survey showed that 83% of the providers agreed that provider-based EMR led to improvement of clinical care, 80% reported improved access to patients' records, and 80% appreciated the automation of providers' tasks. CONCLUSIONS: The introduction of provider-based EMR improved the quality of data collected with a significant reduction in missing and incorrect information. The majority of providers and clients expressed satisfaction with the new system. We recommend the use of provider-based EMR in large HIV programs in Sub-Saharan Africa

The use of census migration data to approximate human movement patterns across temporal scales

Human movement plays a key role in economies and development, the delivery of services, and the spread of infectious diseases. However, it remains poorly quantified partly because reliable data are often lacking, particularly for low-income countries. The most widely available are migration data from human population censuses, which provide valuable information on relatively long timescale relocations across countries, but do not capture the shorter-scale patterns, trips less than a year, that make up the bulk of human movement. Census-derived migration data may provide valuable proxies for shorter-term movements however, as substantial migration between regions can be indicative of well connected places exhibiting high levels of movement at finer time scales, but this has never been examined in detail. Here, an extensive mobile phone usage data set for Kenya was processed to extract movements between counties in 2009 on weekly, monthly, and annual time scales and compared to data on change in residence from the national census conducted during the same time period. We find that the relative ordering across Kenyan counties for incoming, outgoing and between-county movements shows strong correlations. Moreover, the distributions of trip durations from both sources of data are similar, and a spatial interaction model fit to the data reveals the relationships of different parameters over a range of movement time scales. Significant relationships between census migration data and fine temporal scale movement patterns exist, and results suggest that census data can be used to approximate certain features of movement patterns across multiple temporal scales, extending the utility of census-derived migration data