Staff Capacities for Inclusive Teaching and Learning of Students with Visual Impairment: A Case of Public Universities in Uganda

Enrolment of students with visual impairment (SVIs) into higher education is rising globally, hence the need for inclusive learning environments and practices in universities. Academic staff are pivotal in ensuring inclusive practices in universities, given their pedagogic roles. Drawing on a larger project, this paper explores academic staff capacities for inclusive teaching and learning of SVIs in three public universities in Uganda. The study employed a qualitative interpretivist approach, specifically a case study design, and was theoretically informed by the social model of disability. Data was collected from three purposively selected public universities that enrol SVIs, from a sample of 73 respondents, comprising 17 academic staff, 09 academic leaders (4 Faculty Deans, 5 Heads of departments), 29 SVIs, and 18 administrative staff, using interviews, focus group discussions (FGDs), document analysis and non-participant observations. All data sets were analysed thematically. Findings show minimal staff capacities for inclusive teaching and learning of SVIs. The majority of the staff lacked awareness and sensitivity to the SVIs’ learning needs due to poor coordination and information flow across university units that interface with students with disabilities. Staff capacities to adapt teaching and assessment processes for SVIs were also low, attributed to a lack of formal training and orientation in teaching SVIs, except for staff with academic backgrounds in special education and disability studies. The findings underscore the role of staff training in inclusive practices informed by Universal Design for Learning (UDL) principles and better coordination among university units for holistic, inclusive participation of SVI

Lower back pain amongst medical trainees in clinical rotations: implications for choosing future career regarding medical practice

BackgroundLow back pain (LBP) is an increasing concern amongst medical students. There is a dearth of publications regarding how the occurrence of LBP impact medical trainees’ career decisions.ObjectiveTo determine: (i) the point and annual prevalence of LBP amongst Ugandan medical students, (ii) its associated factors, and (iii) whether the experience of LBP during clinical rotations influence medical students’ career choices regarding medical practice.MethodsA multi-center cross-sectional study of 387 randomly selected clinical-phase students was conducted in three Ugandan medical schools, during 17th January to 10th March 2023. Proportions of participants with current and 12-months history of LBP were computed as well as odds for career prospects. We performed binary logistic regression models to determine factors associated with LBP at 95% confidence interval regarding p < 0.05 as statistically significant.ResultsThe response rate was 100%. Participants’ mean age was 24.7 ± 3.2 years of which 66.2% (256/387) were males. The point and annual prevalence of LBP was 52.5% (203/387) and 66.1% (256/387) respectively. Age [OR 1.23, 95% CI (1.03–1.47), p = 0.02], time spent sitting per day [OR 1.08, 95% CI (1.06–1.3), p < 0.01], perceived influence of LBP on future medical career [OR 4.75, 95% CI (1.87–12.06), p < 0.01] were the significant predictors of LBP. LBP interrupted the students’ learning for at least 6.8 ± 12.8 h in 42.4% of participants. Nearly half of participants affirmed that their LBP experience would influence their career prospects. Based on their LBP experiences, trainees ruled out surgery 51.5% (172/334), obstetrics/gynecology 29.6% (99/334), paediatrics 18.3% (61/334), and internal medicine 17.7% (59/334) as their future career specialties. The proportion of trainees that would not consider surgical as opposed to medical disciplines were 81.1% vs. 36.0%, respectively, (p < 0.001).ConclusionThe high prevalence of low back pain among medical students impacts their choices of future medical career with an aversion towards specialization in surgical disciplines. This has far-reaching implications on the disparities in specialist physician health workforce in Low-middle-income countries

How Uganda Reversed Its HIV Epidemic

Uganda is one of only two countries in the world that has successfully reversed the course of its HIV epidemic. There remains much controversy about how Uganda's HIV prevalence declined in the 1990s. This article describes the prevention programs and activities that were implemented in Uganda during critical years in its HIV epidemic, 1987 to 1994. Multiple resources were aggregated to fuel HV prevention campaigns at multiple levels to a far greater degree than in neighboring countries. We conclude that the reversed direction of the HIV epidemic in Uganda was the direct result of these interventions and that other countries in the developing world could similarly prevent or reverse the escalation of HIV epidemics with greater availability of HIV prevention resources, and well designed programs that take efforts to a critical breadth and depth of effort

Significant variations in tolerance to clothianidin and pirimiphos-methyl in Anopheles gambiae and Anopheles funestus populations during a dramatic malaria resurgence despite sustained indoor residual spraying in Uganda

Background: A dramatic malaria resurgence occurred in areas of Uganda between 2020 and 2022, coinciding with the switch to clothianidin-based formulations for indoor residual spraying. During the resurgence, Anopheles funestus sensu lato (s.l.) numbers increased more than those of Anopheles gambiae s.l., but when an alternative insecticide, pirimiphos-methyl, was reintroduced in 2023, both malaria cases and An. funestus mosquito density fell. Methods: In this study, we investigated possible causes of the resurgence by assessing (1) whether sufficient quantities of insecticide were sprayed, (2) the residual insecticide bio-efficacy against wild mosquitoes, and (3) the insecticide susceptibility of both key vector populations using standard test tube assays and wall cone assays. Results: In 2023, after adjusting for extraction efficiency, 70–80% of the houses had optimal residual concentrations of insecticides (clothianidin &gt; 0.3g/m2; pirimiphos-methyl &gt; 0.5g/m2), with significant variations between sampling rounds and wall types. Mud walls had the lowest residual concentration of insecticides, and the lowest observed mortality in wall cone assays, compared to burnt bricks with plaster/cement/paint. In the studies of residual bio-efficacy, by World Health Organization (WHO) definitions, An. funestus s.l. showed resistance to clothianidin (&lt; 80% mortality) up to 11 months, and susceptibility to pirimiphos-methyl (&gt; 90% mortality) when exposed to wall surfaces up to 7 months post-spray. In WHO tube tests, variations were observed in susceptibility to clothianidin in An. funestus s.l. populations using dose– and time–response assays (80–98% mortality). In 2022, An. gambiae s.l. was largely susceptible to the clothianidin-based formulation Sumishield (85–90% mortality), although the levels dropped slightly in 2023 (60–85% mortality), mainly in mud and pole houses. In contrast, An. gambiae s.l. was highly susceptible with mild tolerance to the pirimiphos-methyl-based formulation Actellic (~ 80% mortality), and time–response assays showed that An. gambiae s.l. populations had very low knockdown and mortality at lower exposure time compared to An. funestus s.l. Regression models showed a positive association between residual insecticide concentration (RIC) and mortality in houses sprayed with Sumishield but not Actellic houses. Conclusions: Despite the possible variations observed in spray operations, the study revealed that An. funestus s.l. exhibited a higher tolerance to clothianidin-based formulations compared to An. gambiae s.l., and this might have driven the malaria resurgence observed in Uganda. However, there are signals of An. gambiae s.l. resistance to pirimiphos-methyl, which will require further investigation and monitoring.</p

Prevalence of tuberculous lesion in cattle slaughtered in Mubende district, Uganda

BACKGROUND: The aim of this study was to estimate the prevalence of gross pathology suggestive of bovine tuberculosis (TB-like lesions) and evaluate animal’s characteristics associated with the risk of having bovine TB-like lesions among cattle slaughtered in Mubende district in the Uganda cattle corridor. METHOD: We conducted a cross sectional study in which 1,576 slaughtered cattle in Mubende district municipal abattoir underwent post-mortem inspection between August 2013 and January 2014. The presence of bovine TB-like lesions in addition to the animal’s sex, age, breed, and sub-county of origin prior to slaughter were recorded. Associations between the presence of bovine TB-like lesions and animal’s age, sex, breed, and sub-county of origin prior to slaughter were initially analysed using a univariable approach with the chi-square test, and subsequently with a multivariable logistic regression model to assess the combined impact of these animal characteristics with the risk of having a bovine TB-like lesion. Additionally, and as a secondary objective, tissue samples were collected from all carcases that had a bovine TB-like lesion and were processed using standard Mycobacterium culture and identification methods. The culture and acid fast positive samples were tested using Capilia TB-neo® assay to identify Mycobacterium tuberculosis complex (MTC). RESULTS: Of 1,576 carcasses inspected, 9.7% (153/1,576) had bovine TB-like lesions from which Mycobacterium spp and Mycobacterium Tuberculosis Complex (MTC) were isolated in 13 (8.4%) and 12 (7.8%) respectively. Bovine TB-like lesions were more likely to be found in females (OR = 1.49, OR 95% CI: 1.06–2.13) and in older cattle (OR = 2.5, 95% CI: 1.64–3.7). When compared to Ankole cattle, Cross breed (OR = 6.5, OR 95% CI: 3.37–12.7) and Zebu cattle (OR = 2.57, 95% CI: 1.78–3.72) had higher odds of having bovine TB-like lesions. Animals from Kasanda (OR = 2.5, 95% CI: 1.52–4.17) were more likely to have bovine TB-like lesions than cattle from Kasambya. CONCLUSIONS: The findings of study reveals that approximately one in ten slaughtered cattle presents with gross pathology suggestive of bovine TB in Mubende district in the Uganda cattle corridor district, however, we isolated MTC in only 8.4% of these bovine TB-like lesions. Therefore, there is a need to understand the cause of all the other bovine TB-like lesions in order to safe guard diagnostic integrity of meat inspection in Uganda

Use of RDTs to improve malaria diagnosis and fever case management at primary health care facilities in Uganda

<p>Abstract</p> <p>Background</p> <p>Early and accurate diagnosis of malaria followed by prompt treatment reduces the risk of severe disease in malaria endemic regions. Presumptive treatment of malaria is widely practised where microscopy or rapid diagnostic tests (RDTs) are not readily available. With the introduction of artemisinin-based combination therapy (ACT) for treatment of malaria in many low-resource settings, there is need to target treatment to patients with parasitologically confirmed malaria in order to improve quality of care, reduce over consumption of anti-malarials, reduce drug pressure and in turn delay development and spread of drug resistance. This study evaluated the effect of malaria RDTs on health workers' anti-malarial drug (AMD) prescriptions among outpatients at low level health care facilities (LLHCF) within different malaria epidemiological settings in Uganda.</p> <p>Methods</p> <p>All health workers (HWs) in 21 selected intervention (where RDTs were deployed) LLHF were invited for training on the use RDTs. All HWs were trained to use RDTs for parasitological diagnosis of all suspected malaria cases irrespective of age. Five LLHCFs with clinical diagnosis (CD only) were included for comparison. Subsequently AMD prescriptions were compared using both a 'pre - post' and 'intervention - control' analysis designs. In-depth interviews of the HWs were conducted to explore any factors that influence AMD prescription practices.</p> <p>Results</p> <p>A total of 166,131 out-patient attendances (OPD) were evaluated at 21 intervention LLHCFs. Overall use of RDTs resulted in a 38% point reduction in AMD prescriptions. There was a two-fold reduction (RR 0.62, 95% CI 0.55-0.70) in AMD prescription with the greatest reduction in the hypo-endemic setting (RR 0.46 95% CI 0.51-0.53) but no significant change in the urban setting (RR1.01, p-value = 0.820). Over 90% of all eligible OPD patients were offered a test. An average of 30% (range 25%-35%) of the RDT-negative fever patients received AMD prescriptions. When the test result was negative, children under five years of age were two to three times more likely (OR 2.6 p-value <0.001) to receive anti-malarial prescriptions relative to older age group. Of the 63 HWs interviewed 92% believed that a positive RDT result confirmed malaria, while only 49% believed that a negative RDT result excluded malaria infection.</p> <p>Conclusion</p> <p>Use of RDTs resulted in a 2-fold reduction in anti-malarial drug prescription at LLHCFs. The study demonstrated that RDT use is feasible at LLHCFs, and can lead to better targetting of malaria treatment. Nationwide deployment of RDTs in a systematic manner should be prioritised in order to improve fever case management. The process should include plans to educate HWs about the utility of RDTs in order to maximize acceptance and uptake of the diagnostic tools and thereby leading to the benefits of parasitological diagnosis of malaria.</p

Brain structure and function: a multidisciplinary pipeline to study hominoid brain evolution

To decipher the evolution of the hominoid brain and its functions, it is essential to conduct comparative studies in primates, including our closest living relatives. However, strong ethical concerns preclude in vivo neuroimaging of great apes. We propose a responsible and multidisciplinary alternative approach that links behavior to brain anatomy in non-human primates from diverse ecological backgrounds. The brains of primates observed in the wild or in captivity are extracted and fixed shortly after natural death, and then studied using advanced MRI neuroimaging and histology to reveal macro- and microstructures. By linking detailed neuroanatomy with observed behavior within and across primate species, our approach provides new perspectives on brain evolution. Combined with endocranial brain imprints extracted from computed tomographic scans of the skulls these data provide a framework for decoding evolutionary changes in hominin fossils. This approach is poised to become a key resource for investigating the evolution and functional differentiation of hominoid brains.</jats:p

Procalcitonin Is Not a Reliable Biomarker of Bacterial Coinfection in People With Coronavirus Disease 2019 Undergoing Microbiological Investigation at the Time of Hospital Admission

Admission procalcitonin measurements and microbiology results were available for 1040 hospitalized adults with coronavirus disease 2019 (from 48 902 included in the International Severe Acute Respiratory and Emerging Infections Consortium World Health Organization Clinical Characterisation Protocol UK study). Although procalcitonin was higher in bacterial coinfection, this was neither clinically significant (median [IQR], 0.33 [0.11–1.70] ng/mL vs 0.24 [0.10–0.90] ng/mL) nor diagnostically useful (area under the receiver operating characteristic curve, 0.56 [95% confidence interval, .51–.60])

Oral abstracts of the 21st International AIDS Conference 18-22 July 2016, Durban, South Africa

The rate at which HIV-1 infected individuals progress to AIDS is highly variable and impacted by T cell immunity. CD8 T cell inhibitory molecules are up-regulated in HIV-1 infection and associate with immune dysfunction. We evaluated participants (n=122) recruited to the SPARTAC randomised clinical trial to determine whether CD8 T cell exhaustion markers PD-1, Lag-3 and Tim-3 were associated with immune activation and disease progression.Expression of PD-1, Tim-3, Lag-3 and CD38 on CD8 T cells from the closest pre-therapy time-point to seroconversion was measured by flow cytometry, and correlated with surrogate markers of HIV-1 disease (HIV-1 plasma viral load (pVL) and CD4 T cell count) and the trial endpoint (time to CD4 count <350 cells/μl or initiation of antiretroviral therapy). To explore the functional significance of these markers, co-expression of Eomes, T-bet and CD39 was assessed.Expression of PD-1 on CD8 and CD38 CD8 T cells correlated with pVL and CD4 count at baseline, and predicted time to the trial endpoint. Lag-3 expression was associated with pVL but not CD4 count. For all exhaustion markers, expression of CD38 on CD8 T cells increased the strength of associations. In Cox models, progression to the trial endpoint was most marked for PD-1/CD38 co-expressing cells, with evidence for a stronger effect within 12 weeks from confirmed diagnosis of PHI. The effect of PD-1 and Lag-3 expression on CD8 T cells retained statistical significance in Cox proportional hazards models including antiretroviral therapy and CD4 count, but not pVL as co-variants.Expression of ‘exhaustion’ or ‘immune checkpoint’ markers in early HIV-1 infection is associated with clinical progression and is impacted by immune activation and the duration of infection. New markers to identify exhausted T cells and novel interventions to reverse exhaustion may inform the development of novel immunotherapeutic approaches