Health, wellbeing and nutrition: Domain report

The escalation of global political, economic and ecological crises and associated price surges has contributed to interdependent forms of malnutrition – undernutrition, overweight and obesity – with enduring societal consequences. This study investigates the factors influencing the adoption of healthy diets in five African cities – Bukavu, DRC, Freetown, Sierra Leone, Kampala, Uganda, Lilongwe, Malawi and Nairobi, Kenya. It explores the engagement of policymakers, consumers, private actors and further stakeholders in food and health systems. Across all cities, rising food insecurity and the prevalence of non-communicable diseases (NCDs) linked to unhealthy dietary patterns, notably around consumption of ultra-processed foods, are observed. Despite urban residents generally experiencing lower food insecurity than rural counterparts, people with low incomes, particularly those living in informal settlements, remain vulnerable. Additional axes of vulnerability that intersect with low incomes are gender, age, disability and migrant/refugee status. Socioeconomic drivers that exacerbate food and nutrition insecurity include the high cost of nutritious diets, inadequate market, road, water and sanitation infrastructures, and the proliferation of unhealthy processed foods. Policy responses predominantly prioritise food quantity over quality, overlooking the importance of healthy diets. Additionally, profit-driven dynamics, within food and healthcare systems, and inconsistent resident knowledge of healthy, balanced diets, perpetuate the cycle of ill-health driven by poor nutrition, while informal food vendors, vital for low-income urbanites, face neglect or harassment. However, city governments possess avenues for intervention, such as awareness campaigns, social security mechanisms, and social and technical infrastructure support for water and sanitation, markets and street vendors. Primary healthcare services and community health workers play crucial roles in addressing malnutrition, youth development and adolescent health. Multisectoral collaboration is advocated for broadening the impact of strategic interventions from neighbourhood to city level. Reform efforts necessitate broad coalitions, encompassing governments, civil society and the private sector

Whole genome sequences of multi-drug resistant Escherichia coli isolated in a Pastoralist Community of Western Uganda: Phylogenomic changes, virulence and resistant genes.

BACKGROUND:The crisis of antimicrobial resistance is already here with us, affecting both humans and animals alike and very soon, small cuts and surgeries will become life threatening. This study aimed at determine the whole genome sequences of multi-drug resistant Escherichia coli isolated in a Pastoralist Community of Western Uganda: phylogenomic changes, virulence and resistant genes. METHODS:This was a laboratory based cross sectional study. Bacterial isolates analyzed in this study were 42 multidrug resistant E. coli isolated from stool samples from both humans (n = 30) and cattle (n = 12) in pastoralist communities collected between January 2018-March 2019. Most of the isolates (41/42) were resistant to three or more antibiotics (multi-drug resistant) and 21/42 isolates were ESBL producers; 13/30 from human and 8/12 from cattle. Whole Genome Sequencing (WGS) was carried out at the facilities of Kenya Medical Research Institute-Wellcome trust, Kilifi, to determine the phylogenomic changes, virulence and resistant genes. RESULTS:At household level, the genomes from both human and animals clustered away from one another except for one instance where two human isolates from the same household clustered together. However, 67% of the E. coli isolated from cattle were closely related to those found in humans. The E. coli isolates were assigned to eight different phylogroups: A, B1, B2, Cladel, D, E, F and G, with a majority being assigned to phylogroup A; while most of the animal isolates were assigned to phylogroup B1. The carriage of multiple AMR genes was higher from the E. coli population from humans than those from cattle. Among these were Beta-lactamase; blaOXA-1: Class D beta-lactamases; blaTEM-1, blaTEM-235: Beta-lactamase; catA1: chloramphenicol acetyl transferase; cmlA1: chloramphenicol efflux transporter; dfrA1, dfrA12, dfrA14, dfrA15, dfrA17, dfrA5, dfrA7, dfrA8: macrolide phosphotransferase; oqxB11: RND efflux pump conferring resistance to fluoroquinolone; qacL, qacEdelta1: quinolone efflux pump; qnrS1: quinolone resistance gene; sul1, sul2, sul3: sulfonamide resistant; tet(A), tet(B): tetracycline efflux pump. A high variation of virulence genes was registered among the E. coli genomes from humans than those of cattle origin. CONCLUSION:From the analysis of the core genome and phenotypic resistance, this study has demonstrated that the E. coli of human origin and those of cattle origin may have a common ancestry. Limited sharing of virulence genes presents a challenge to the notion that AMR in humans is as a result of antibiotic use in the farm and distorts the picture of the directionality of transmission of AMR at a human-animal interface and presents a task of exploring alternative routes of transmission of AMR

Implementation of the World Health Organization Global Antimicrobial Resistance Surveillance System in Uganda, 2015-2020: Mixed-Methods Study Using National Surveillance Data

BackgroundAntimicrobial resistance (AMR) is an emerging public health crisis in Uganda. The World Health Organization (WHO) Global Action Plan recommends that countries should develop and implement National Action Plans for AMR. We describe the establishment of the national AMR program in Uganda and present the early microbial sensitivity results from the program. ObjectiveThe aim of this study is to describe a national surveillance program that was developed to perform the systematic and continuous collection, analysis, and interpretation of AMR data. MethodsA systematic qualitative description of the process and progress made in the establishment of the national AMR program is provided, detailing the progress made from 2015 to 2020. This is followed by a report of the findings of the isolates that were collected from AMR surveillance sites. Identification and antimicrobial susceptibility testing (AST) of the bacterial isolates were performed using standard methods at both the surveillance sites and the reference laboratory. ResultsRemarkable progress has been achieved in the establishment of the national AMR program, which is guided by the WHO Global Laboratory AMR Surveillance System (GLASS) in Uganda. A functional national coordinating center for AMR has been established with a supporting designated reference laboratory. WHONET software for AMR data management has been installed in the surveillance sites and laboratory staff trained on data quality assurance. Uganda has progressively submitted data to the WHO GLASS reporting system. Of the 19,216 isolates from WHO GLASS priority specimens collected from October 2015 to June 2020, 22.95% (n=4411) had community-acquired infections, 9.46% (n=1818) had hospital-acquired infections, and 68.57% (n=12,987) had infections of unknown origin. The highest proportion of the specimens was blood (12,398/19,216, 64.52%), followed by urine (5278/19,216, 27.47%) and stool (1266/19,216, 6.59%), whereas the lowest proportion was urogenital swabs (274/19,216, 1.4%). The mean age was 19.1 (SD 19.8 years), whereas the median age was 13 years (IQR 28). Approximately 49.13% (9440/19,216) of the participants were female and 50.51% (9706/19,216) were male. Participants with community-acquired infections were older (mean age 28, SD 18.6 years; median age 26, IQR 20.5 years) than those with hospital-acquired infections (mean age 17.3, SD 20.9 years; median age 8, IQR 26 years). All gram-negative (Escherichia coli, Klebsiella pneumoniae, and Neisseria gonorrhoeae) and gram-positive (Staphylococcus aureus and Enterococcus sp) bacteria with AST showed resistance to each of the tested antibiotics. ConclusionsUganda is the first African country to implement a structured national AMR surveillance program in alignment with the WHO GLASS. The reported AST data indicate very high resistance to the recommended and prescribed antibiotics for treatment of infections. More effort is required regarding quality assurance of laboratory testing methodologies to ensure optimal adherence to WHO GLASS–recommended pathogen-antimicrobial combinations. The current AMR data will inform the development of treatment algorithms and clinical guidelines

Proportion of <i>E</i>. <i>coli and K</i>. <i>pneumoniae</i> isolates resistant to drugs classes and individual drugs.

<p>Proportion of <i>E</i>. <i>coli and K</i>. <i>pneumoniae</i> isolates resistant to drugs classes and individual drugs.</p

Study profile.

<p>Study profile.</p

Multidrug resistance among <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i> carried in the gut of out-patients from pastoralist communities of Kasese district, Uganda

<div><p>Background</p><p>Antimicrobial resistance is a worldwide public health emergency that requires urgent attention. Most of the effort to prevent this coming catastrophe is occurring in high income countries and we do not know the extent of the problem in low and middle-income countries, largely because of low laboratory capacity coupled with lack of effective surveillance systems. We aimed at establishing the magnitude of antimicrobial resistance among <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i> carried in the gut of out-patients from pastoralist communities of rural Western Uganda.</p><p>Methods</p><p>A cross-sectional study was carried out among pastoralists living in and around the Queen Elizabeth Protected Area (QEPA). Stool samples were collected from individuals from pastoralist communities who presented to the health facilities with fever and/or diarrhea without malaria and delivered to the microbiology laboratory of College of Health Sciences-Makerere University for processing, culture and drug susceptibility testing.</p><p>Results</p><p>A total of 300 participants fulfilling the inclusion criteria were recruited into the study. Three hundred stool samples were collected, with 209 yielding organisms of interest. Out of 209 stool samples that were positive, 181 (89%) grew <i>E</i>. <i>coli</i>, 23 (11%) grew <i>K</i>. <i>pneumonia</i>e and five grew Shigella. Generally, high antibiotic resistance patterns were detected among <i>E</i>. <i>coli</i> and <i>K</i>. <i>pneumoniae</i> isolated. High resistance against cotrimoxazole 74%, ampicillin 67%, amoxicillin/clavulanate 37%, and ciprofloxacin 31% was observed among the <i>E</i>. <i>coli</i>. In <i>K</i>. <i>pneumoniae</i>, cotrimoxazole 68% and amoxicillin/clavulanate 46%, were the most resisted antimicrobials. Additionally, 57% and 82% of the <i>E</i>. <i>coli</i> and <i>K</i>. <i>pneumoniae</i> respectively were resistant to at least three classes of the antimicrobials tested. Resistance to carbapenems was not detected among <i>K</i>. <i>pneumoniae</i> and only 0.6% of the <i>E</i>. <i>coli</i> were resistant to carbapenems. Isolates producing ESBLs comprised 12% and 23% of <i>E</i>. <i>coli</i> and <i>K</i>. <i>pneumoniae</i> respectively.</p><p>Conclusion</p><p>We demonstrated high antimicrobial resistance, including multidrug resistance, among <i>E</i>. <i>coli</i> and <i>K</i>. <i>pneumoniae</i> isolates from pastoralist out-patients. We recommend a One Health approach to establish the sources and drivers of this problem to inform public health.</p></div

Socio demographic characteristics and distribution of drug resistance.

<p>Socio demographic characteristics and distribution of drug resistance.</p

Map of Kasese district showing the distribution of health facilities.

<p>Map of Kasese district showing the distribution of health facilities.</p

Magnitude and trends in cervical cancer at Mbarara Regional Referral Hospital in South Western Uganda: Retrospective analysis of data from 2017-2022.

High-income countries have documented a significant decline in the incidence and mortality of cervical cancer over the past decade but such data from low and middle-income countries such as Uganda is limited to ascertain trends. There is also paucity of data on the burden of cervical cancer in comparison to other gynaecologic malignancies and there is a likelihood that the incidence might be on the rise. To describe the current trends and magnitude of cervical cancer in comparison to other gynaecological malignancies histological types, we conducted a retrospective records review of charts of patients admitted with gynaecological malignancies on the gynaecological ward of Mbarara Regional Referral Hospital (MRRH) between January 2017 and December 2022. Of 875 patients with gynaecological malignancies admitted to the MRRH in the 6-year review period, 721 (82.4%) had cervical cancer. Patients with cervical cancer were significantly older than those with other gynaecological malignancies: (50.2±11.5 versus 43.8± 15.0 respectively, p<0.001). Between 2017 and 2022, cervical cancer rates increased by 17% annually compared to other gynaecological cancers (OR:1.17; 95% CI 1.06-1.28, p = 0.0046), with the majority of patients of cervical cancer patients (92.7%, n = 668) having squamous cell carcinoma. Most patients (87.9%, n = 634) had late-stage disease (stage 2 and above) and were referred to the Uganda Cancer Institute for chemoradiation. These results imply that there is a need to scale up screening services and other preventive measures such as vaccination against human papilloma virus

Long-term dominance of Mycobacterium tuberculosis Uganda family in peri-urban Kampala-Uganda is not associated with cavitary disease

Previous studies have shown that Mycobacterium tuberculosis (MTB) Uganda family, a sub-lineage of the MTB Lineage 4, is the main cause of tuberculosis (TB) in Uganda. Using a well characterized patient population, this study sought to determine whether there are clinical and patient characteristics associated with the success of the MTB Uganda family in Kampala.; A total of 1,746 MTB clinical isolates collected from1992-2009 in a household contact study were genotyped. Genotyping was performed using Single Nucleotide Polymorphic (SNP) markers specific for the MTB Uganda family, other Lineage 4 strains, and Lineage 3, respectively. Out of 1,746 isolates, 1,213 were from patients with detailed clinical data. These data were used to seek associations between MTB lineage/sub-lineage and patient phenotypes.; Three MTB lineages were found to dominate the MTB population in Kampala during the last two decades. Overall, MTB Uganda accounted for 63% (1,092/1,746) of all cases, followed by other Lineage 4 strains accounting for 22% (394/1,746), and Lineage 3 for 11% (187/1,746) of cases, respectively. Seventy-three (4 %) strains remained unclassified. Our longitudinal data showed that MTB Uganda family occurred at the highest frequency during the whole study period, followed by other Lineage 4 strains and Lineage 3. To explore whether the long-term success of MTB Uganda family was due to increased virulence, we used cavitary disease as a proxy, as this form of TB is the most transmissible. Multivariate analysis revealed that even though cavitary disease was associated with known risk factors such as smoking (adjusted odds ratio (aOR) 4.8, 95% confidence interval (CI) 3.33-6.84) and low income (aOR 2.1, 95% CI 1.47-3.01), no association was found between MTB lineage and cavitary TB.; The MTB Uganda family has been dominating in Kampala for the last 18 years, but this long-term success is not due to increased virulence as defined by cavitary disease