Dairy farming in Uganda. Production Efficiency and Soil Nutrients under Different Farming Systems

Prior to the 1980s, milk production in Uganda occurred largely in two contrasting production systems. In the wetter parts of the country, especially in the southwest, there were a few large, mostly government-owned commercial dairy farms on which exotic and cross-bred dairy cattle were kept in paddocks and grazed on improved or natural pastures. In the drier eastern and northeastern parts of the country, pastoralists kept large numbers of local cattle breeds, notably the Small East African Zebu (SEAZ), under traditional extensive management systems. Although the pastoralists marketed some milk, most was consumed by the household. Cattle were also valued as an expression of cultural prestige and a means of accumulating capital and meeting planned and emergency expenses. Smallholders, who tended to keep a few low yielding indigenous cattle as well as growing crops, made little contribution to the nation’s marketed milk and were primarily subsistence-oriented

Categorisation of dairy production systems: A strategy for targeting meaningful development of the systems in Uganda

Dairy production is a major contributor towards national economies and household food security and incomes in sub-Saharan Africa (SSA). Milk production in the region is estimated at 1.27 million metric tonnes year-1. However, this level of milk production is inadequate for the existing human population who would require 103 million metric tonnes year-1. In Uganda, milk production only meets approximately 20% of the population's nutritional requirements. As such, methods need to be sought to increase milk production in the region. Research efforts have made strides in identifying the causes of the production-demand gap in the SSA region and a spectrum of interventions to bolster the productivity. Unfortunately, these efforts have by far yielded insignificant results. First and foremost, for exploiting the full potential of the dairy cattle population in the region, among the critical elements often overlooked in research and development processes is the recognition of systematic parametric variations within the sector, which if considered could provide entry-points for targeting intervention efforts. One such high potential entry-point is the recognition of the existence of a dairy intensification "vector" across a country or region, along which exist sections with sequentially marked nuclei of fairly uniform socio-economic and biophysical dairy sub-systems features. To enhance the process of targeting research and development in the Ugandan dairy sector, dairy production systems in the country were categorised on basis of level of intensification of production. Data were collected from 300 households in Mbarara, Masaka and Jinja districts in Uganda. The major variables derived from the data for the categorisation process were those related with milk production, expenditure, income, land area and cattle herds. The data was subjected to a cluster analysis which although produced 16 groups only five had prominent membership (above 5% of the farms). The five major clusters were selected as representative of the dairy production systems. A ranking system was used to develop an intensification continuum for the 5 systems. Herding-on own and communal land (cluster 9) was the least intensive, this was followed by Herding-mainly on own land (cluster 12) and Fenced (cluster 8) respectively. Semi-Zero Grazing (cluster 15) and Zero Grazing (cluster 13) were the most intensive dairy production systems with the latter being at the highest end of the continuum

\u3cem\u3eEscherichia coli\u3c/em\u3e Pathogen O157:H7 Does Not Survive Longer In Soil Than A Nonpathogenic Fecal Coliform

Survival rates for individual types of fecal organisms are quite different. Although some pathogens may persist as long as 5 years in soil, most fecal pathogens from human and animal waste usually die very quickly. Two to three months is sufficient in most cases to reduce pathogens to negligible numbers once they have been excreted or land-applied in animal wastes. It is expensive and time- consuming to test for individual pathogens. Consequently, nonpathogenic fecal indicator bacteria, which are easily and inexpensively detected, are often used to study pathogen survival in soil and water. Current methods for rapidly detecting fecal indicator bacteria use the capacity of fecal coliforms (e.g. Escherichia coli) to metabolize a fluorescent indicator compound, 4-methylumbelliferyl ß-D-glucuronide (MUG) as evidence for fecal contamination

Mortality of Escherichia coli O157:H7 in Two Soils with Different Physical and Chemical Properties

Wild and domesticated animals can harbor a pathogenic Escherichia coli strain designated as O157:H7. Potential health problems could occur if strain O157:H7 is a more robust survivor in defecated waste than commonly used indicator bacteria. A laboratory study was conducted to assess E. coli O157:H7 survival relative to a nonpathogenie E. coli strain in two soils with different physical and chemical characteristics. Bacteria in the inoculated soils were enumerated on a weekly basis for 8 wk using a most probable number (MPN) technique. First-order decay models were used to describe bacteria mortality in the soils. Decay series were described slightly better by a two-stage function than by a single-stage function. Strain O157:H7 exhibited similar mortality patterns to the nonpathogenic E. coli in the same soil environment. Both E. coli strains had greater mortality rates in Pope silt loam (coarse-loamy, mixed, active, mesic Fluventic Dystrudept) than Zanesville silt loam (fine-silty, mixed, active, mesic Oxyaquic Fragiudalf). Differences in available soil water probably were the overriding factor in E. coli survival. Escherichia coli O157:H7 survival could be modeled in the same way as nonpathogenic E. coli and appears to have a slightly higher mortality rate

Mortality of Escherichia coli O157:H7 in Two Soils with Different Physical and Chemical Properties

Wild and domesticated animals can harbor a pathogenic Escherichia coli strain designated as O157:H7. Potential health problems could occur if strain O157:H7 is a more robust survivor in defecated waste than commonly used indicator bacteria. A laboratory study was conducted to assess E. coli O157:H7 survival relative to a nonpathogenie E. coli strain in two soils with different physical and chemical characteristics. Bacteria in the inoculated soils were enumerated on a weekly basis for 8 wk using a most probable number (MPN) technique. First-order decay models were used to describe bacteria mortality in the soils. Decay series were described slightly better by a two-stage function than by a single-stage function. Strain O157:H7 exhibited similar mortality patterns to the nonpathogenic E. coli in the same soil environment. Both E. coli strains had greater mortality rates in Pope silt loam (coarse-loamy, mixed, active, mesic Fluventic Dystrudept) than Zanesville silt loam (fine-silty, mixed, active, mesic Oxyaquic Fragiudalf). Differences in available soil water probably were the overriding factor in E. coli survival. Escherichia coli O157:H7 survival could be modeled in the same way as nonpathogenic E. coli and appears to have a slightly higher mortality rate

Strengthening the community health worker programme for health improvement through enhancing training, supervision and motivation in Wakiso district, Uganda

Objective: The objective of the project was to strengthen the community health worker (CHW) programme in Ssisa sub-county, Wakiso district, Uganda by providing a coherent, structured and standardized training, supervision and motivation package so as to enhance their performance. Results: The project trained all 301 CHWs who received non-financial incentives of t-shirts, gumboots and umbrellas, and 75 of them received solar equipment to support lighting their houses and charging phones. Twenty-four of the CHWs who had coordination roles received additional training. Three motorcycles were also provided to enhance transportation of CHW coordinators during their work including supervision. By end of the project, the CHWs had conducted 40,213 household visits, carried out health education sessions with 127,011 community members, and treated 19,387 children under 5 years of age. From the project evaluation, which used both quantitative and qualitative methods, 98% of the CHWs reported having improved competence in performance of their roles. In addition, the CHWs were highly motivated to do their work. The motorcycles were instrumental in supporting the work of CHW coordinators including monthly collection of reports and distribution of medicines. The project demonstrated that by improving training, supervision and motivation, performance of CHW programmes can be enhanced

Integrated community case management in a peri-urban setting: a qualitative evaluation in Wakiso District, Uganda.

Integrated community case management (iCCM) strategies aim to reach poor communities by providing timely access to treatment for malaria, pneumonia and diarrhoea for children under 5 years of age. Community health workers, known as Village Health Teams (VHTs) in Uganda, have been shown to be effective in hard-to-reach, underserved areas, but there is little evidence to support iCCM as an appropriate strategy in non-rural contexts. This study aimed to inform future iCCM implementation by exploring caregiver and VHT member perceptions of the value and effectiveness of iCCM in peri-urban settings in Uganda.A qualitative evaluation was conducted in seven villages in Wakiso district, a rapidly urbanising area in central Uganda. Villages were purposively selected, spanning a range of peri-urban settlements experiencing rapid population change. In each village, rapid appraisal activities were undertaken separately with purposively selected caregivers (n = 85) and all iCCM-trained VHT members (n = 14), providing platforms for group discussions. Fifteen key informant interviews were also conducted with community leaders and VHT members. Thematic analysis was based on the 'Health Access Livelihoods Framework'.iCCM was perceived to facilitate timely treatment access and improve child health in peri-urban settings, often supplanting private clinics and traditional healers as first point of care. Relative to other health service providers, caregivers valued VHTs' free, proximal services, caring attitudes, perceived treatment quality, perceived competency and protocol use, and follow-up and referral services. VHT effectiveness was perceived to be restricted by inadequate diagnostics, limited newborn care, drug stockouts and VHT member absence - factors which drove utilisation of alternative providers. Low community engagement in VHT selection, lack of referral transport and poor availability of referral services also diminished perceived effectiveness. The iCCM strategy was widely perceived to result in economic savings and other livelihood benefits.In peri-urban areas, iCCM was perceived as an effective, well-utilised strategy, reflecting both VHT attributes and gaps in existing health services. Depending on health system resources and organisation, iCCM may be a useful transitional service delivery approach. Implementation in peri-urban areas should consider tailored community engagement strategies, adapted selection criteria, and assessment of population density to ensure sufficient coverage

Growth, immune and viral responses in HIV infected African children receiving highly active antiretroviral therapy: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>Scale up of paediatric antiretroviral therapy in resource limited settings continues despite limited access to routine laboratory monitoring. We documented the weight and height responses in HIV infected Ugandan children on highly active antiretroviral therapy and determined clinical factors associated with successful treatment outcomes.</p> <p>Methods</p> <p>A prospective cohort of HIV infected children were initiated on HAART and followed for 48 weeks. Body mass index for age z scores(BAZ), weight and height-for-age z scores (WAZ & HAZ) were calculated: CD4 cell % and HIV-1 RNA were measured at baseline and every 12 weeks. Treatment outcomes were classified according to; both virological and immunological success (VS/IS), virological failure and immunological success (VF/IS). virological success and immunological failure (VS/IF) and both virological and immunological failure (VF/IF).</p> <p>Results</p> <p>From March 2004 until May 2006, 124 HIV infected children were initiated on HAART. The median age (IQR) was 5.0 years (2.1 - 7.0) and 49% (61/124) were female. The median [95% confidence interval (CI)] BAZ, WAZ and HAZ at baseline were 0.29 (-2.9, -1.2), -1.2 (-2.1, -0.5) and -2.06 (-2.9, -1.2) respectively. Baseline median CD4 cell % and log10 HIV-1 RNA were; 11.8% (7.5-18.0) and 5.6 (5.2-5.8) copies/ml. By 48 weeks, mean WAZ and HAZ in the VF/IS group, which was younger, increased from - 0.98 (SD 1.7) to + 1.22 (SD 1.2) and from -1.99 (1.7) to + 0.76 (2.4) respectively. Mean increase in WAZ and HAZ in the VS/IF group, an older group was modest, from -1.84 (1.3) to - 0.41 (1.2) and -2.25 (1.2) to -1.16 (1.3) respectively. Baseline CD4 cell % [OR 6.97 95% CI (2.6 -18.6)], age [OR 4.6 95% CI (1.14 -19.1)] and WHO clinical stage [OR 3.5 95%CI (1.05 -12.7)] were associated with successful treatment outcome.</p> <p>Conclusions</p> <p>HIV infected Ugandan children demonstrated a robust increase in height and weight z scores during the first 48 weeks of HAART, including those who failed to completely suppress virus. Older children initiating HAART with severe immune suppression were less likely to achieve a successful treatment outcome. These data emphasize the importance of initiating HAART early to ensure adequate immune and growth responses.</p

Low HIV testing rates among tuberculosis patients in Kampala, Uganda

<p>Abstract</p> <p>Background</p> <p>HIV testing among tuberculosis patients is critical in improving morbidity and mortality as those found to be HIV positive will be offered a continuum of care including ART if indicated. We conducted a cross-sectional study in three Kampala City primary care clinics: to assess the level of HIV test uptake among newly diagnosed pulmonary tuberculosis (PTB) patients; to assess patient and health worker factors associated with HIV test uptake; and to determine factors associated with HIV test uptake at the primary care clinics</p> <p>Methods</p> <p>Adult patients who had been diagnosed with smear-positive PTB at a primary care clinic or at the referral hospital and who were being treated at any of the three clinics were interviewed. Associations between having taken the test as the main outcome and explanatory variables were assessed by multivariate logistic regression.</p> <p>Results</p> <p>Between April and October 2007, 112 adults were included in the study. An HIV test had been offered to 74 (66%). Of the 112 patients, 61 (82%) had accepted the test; 45 (74%) had eventually been tested; and 32 (29%) had received their test results.</p> <p>Patients who were <25 yeas old, female or unemployed, or had reported no previous HIV testing, were more likely to have been tested. The strongest predictor of having been tested was if patients had been diagnosed at the referral hospital compared to the city clinic (adjusted OR 24.2; 95% CI 6.7-87.7; p < 0.001). This primarily reflected an "opt-out" (uptake 94%) versus an "opt-in" (uptake 53%) testing policy.</p> <p>Conclusions</p> <p>The overall HIV test uptake was surprisingly low at 40%. The HIV test uptake was significantly higher among TB patients who were identified at hospital, among females and in the unemployed.</p