Prevalence and morphological types of anaemia and hookworm infestation in the medical emergency ward, Mulago Hospital, Uganda

Introduction. Anaemia is common worldwide, although the burden is highest in developing countries where nutrient deficiencies and chronic infections are prevalent.Objective. To determine the prevalence and morphologicaltypes of anaemia and assess the hookworm burden among patients in the medical emergency ward at Mulago national referral hospital, Uganda.Methods. In a cross-sectional descriptive study 395 patients were recruited by systematic random sampling and their socio-demographic characteristics and clinical details collected. A complete blood count and peripheral film examination were done and stool examined for hookworm ova.Statistical analysis. Data were processed using Epi-Info version 6 and Stata version 9. The chi-square test was used for categorical variables and Student’s t-test for non-categorical variables. Multiple logistic regression was used to determine factors predictive of anaemia.Results. Of the patients 255 (64.6%) had anaemia. The prevalence was higher among males (65.8%) than females (63.7%). Fatigue (odds ratio (OR) 2.1, confidence interval (CI) 1.37 - 3.24), dizziness (OR 1.64, CI 1.07 - 2.44), previous blood transfusion (OR 2.83, CI 1.32 - 6.06), lymphadenopathy (OR 2.99, CI 1.34 - 6.66) and splenomegaly (OR 5.22, CI 1.78 - 15.28) were significantly associated with anaemia.Splenomegaly, low body mass index (BMI)

Splanchnic venous thrombosis driven by a constitutively activated JAK2 V617F philadelphia-negative myeloproliferative neoplasm: a case report

Introduction: Splanchnic venous thrombosis (SVT) has varied etiology with Philadelphia-negative myeloproliferative neoplasms (MPNs) being the most frequent underlying prothrombotic factor. Hematological indices often remain within normal range because of portal hypertension and its sequelae, causing diagnostic challenges. The high frequency of JAK2 mutation among patients with SVT reinforces the diagnostic utility of JAK2 V617F testing.Case report: We report a case of a 62-year-old black man with progressive abdominal swelling and features of decompensated chronic liver disease found to have SVT-portal vein thrombosis and how JAK2 V617F was useful in unmasking an underlying myeloproliferative neoplasm.Conclusion: A high index of suspicion for an underlying prothrombotic factor is critical for patients presenting with thrombosis in unusual sites. This is useful in prognostic stratification and patient outcomes. JAK2 mutation screening is now part of the standard diagnostic workup in SVT.Keywords: venous thrombosis, myeloproliferative neoplasm

Household farm production diversity and micronutrient intake: Where are the linkages? Panel data evidence from Uganda

Open Access Journal; Published online: 02 Apr 2021Hunger and malnutrition are key global challenges whose understanding is instrumental to their elimination, thus realization of important sustainable development goals (SDGs). However, understanding linkages between farm production diversity (FPD) and household micronutrient intake is important in mapping micronutrient deficiencies and hidden hunger. Such understanding would inform appropriate interventions against malnutrition. Unfortunately, empirical literature is scarce to sufficiently inform such understanding. Using nationally representative panel survey data covering about 3300 households, we study linkages between FPD and nutrition, and associated impact pathways. We analyze data using panel regression models. Results show that at least half of sample was deficient in daily energy, iron, zinc, and vitamin A intake vis-à-vis FAO recommendations. Deficiencies were most severe (85%) with vitamin A. Positive and significant associations (about 1% for each added crop/livestock species) exist between FPD and daily household energy, iron, zinc, and vitamin A intake. FPD impacts energy and micronutrient intake via two main consumption pathways; markets (about 0.01% for each shilling), and own farm production (about 0.1% for each shilling). Therefore, own farm production yields better outcomes. Gender effects also exist. Male-headed households exhibited better nutrition outcomes (energy—11%, iron—8%, and zinc—12%) mostly via markets. Effects on Vitamin A were also positive although insignificant

Determinants for deployment of climate-smart integrated pest management practices: a meta-analysis approach

Following the development and dissemination of new climate-smart agricultural technologies to farmers globally, there has been an increase in the number of socio-economic studies on the adoption of climate-smart integrated pests’ management (CS-IPM) technologies over the years. In this study, we review empirical evidence on adoption determinants of CS-IPM technologies and identify possible science-policy interfaces. Generally, our review shows that socioeconomic and institutional factors are influential in shaping CS-IPM adoption decisions of farmers. More specifically, income was found to positively influence the adoption of CS-IPM technologies while land size owned influences CS-IPM adoption negatively. Registered land tenure (registered secure rights) positively influences CS-IPM technologies’ adoption, implying that efficient land markets that enable competitive and fair distribution and access to land, more so by the vulnerable but efficient smallholder producers do indeed increase the adoption of CS-IPMs technologies. Social capital, achieved via farmers’ organizations is also central in fostering CS-IPM technologies’ adoption, just as markets reforms that minimize market failures regarding access to credit, labor, and agricultural information, which could indirectly hinder farmers’ use of CS-IPM practices. Functional extension systems that improve farmers’ awareness of CS-IPM do also improve CS-IPM technologies’ adoption. However, the adoption of CS-IPM technologies in Ghana and Benin is slow-paced because of factors like lack of access to farm inputs that facilitate uptake of these technologies, lack of credit facilities, and limited extension services among others. Interestingly, our review confirms that CS-IPM technologies do indeed reduce and minimize the intensity of pesticide usage and foster ecosystem (environmental and human) health. Therefore, this review unearths strategic determinants of CS-IPM adoption and makes fundamental guidance around climate-smart innovations transfer and environmental policies that should be prioritized to curb environmental pollution and ensure agricultural ecosystems’ sustainability

Survival of Infants Born to HIV-Positive Mothers, by Feeding Modality, in Rakai, Uganda

Data comparing survival of formula-fed to breast-fed infants in programmatic settings are limited. We compared mortality and HIV-free of breast and formula-fed infants born to HIV-positive mothers in a program in rural, Rakai District Uganda.One hundred eighty two infants born to HIV-positive mothers were followed at one, six and twelve months postpartum. Mothers were given infant-feeding counseling and allowed to make informed choices as to whether to formula-feed or breast-feed. Eligible mothers and infants received antiretroviral therapy (ART) if indicated. Mothers and their newborns received prophylaxis for prevention of mother-to-child HIV transmission (pMTCT) if they were not receiving ART. Infant HIV infection was detected by PCR (Roche Amplicor 1.5) during the follow-up visits. Kaplan Meier time-to-event methods were used to compare mortality and HIV-free survival. The adjusted hazard ratio (Adjusted HR) of infant HIV-free survival was estimated by Cox regression. Seventy-five infants (41%) were formula-fed while 107 (59%) were breast-fed. Exclusive breast-feeding was practiced by only 25% of breast-feeding women at one month postpartum. The cumulative 12-month probability of infant mortality was 18% (95% CI = 11%–29%) among the formula-fed compared to 3% (95% CI = 1%–9%) among the breast-fed infants (unadjusted hazard ratio (HR)  = 6.1(95% CI = 1.7–21.4, P-value<0.01). There were no statistically significant differentials in HIV-free survival by feeding choice (86% in the formula-fed compared to 96% in breast-fed group (Adjusted RH = 2.8[95%CI = 0.67–11.7, P-value = 0.16]Formula-feeding was associated with a higher risk of infant mortality than breastfeeding in this rural population. Our findings suggest that formula-feeding should be discouraged in similar African settings

Sub-Optimal Vitamin B-12 Levels among ART-Naïve HIV-Positive Individuals in an Urban Cohort in Uganda

Malnutrition is common among HIV-infected individuals and is often accompanied by low serum levels of micronutrients. Vitamin B-12 deficiency has been associated with various factors including faster HIV disease progression and CD4 depletion in resource-rich settings. To describe prevalence and factors associated with sub-optimal vitamin B-12 levels among HIV-infected antiretroviral therapy (ART) naïve adults in a resource-poor setting, we performed a cross-sectional study with a retrospective chart review among individuals attending either the Mulago-Mbarara teaching hospitals’ Joint AIDS Program (MJAP) or the Infectious Diseases Institute (IDI) clinics, in Kampala, Uganda. Logistic regression was used to determine factors associated with sub-optimal vitamin B-12. The mean vitamin B-12 level was 384 pg/ml, normal range (200–900). Sub-optimal vitamin B-12 levels (<300 pg/ml) were found in 75/204 (36.8%). Twenty-one of 204 (10.3%) had vitamin B-12 deficiency (<200 pg/ml) while 54/204 (26.5%) had marginal depletion (200–300 pg/ml). Irritable mood was observed more among individuals with sub-optimal vitamin B-12 levels (OR 2.5, 95% CI; 1.1–5.6, P = 0.03). Increasing MCV was associated with decreasing serum B-12 category; 86.9 fl (±5.1) vs. 83 fl (±8.4) vs. 82 fl (±8.4) for B-12 deficiency, marginal and normal B-12 categories respectively (test for trend, P = 0.017). Compared to normal B-12, individuals with vitamin B-12 deficiency had a longer known duration of HIV infection: 42.2 months (±27.1) vs. 29.4 months (±23.8; P = 0.02). Participants eligible for ART (CD4<350 cells/µl) with sub-optimal B-12 had a higher mean rate of CD4 decline compared to counterparts with normal B-12; 118 (±145) vs. 22 (±115) cells/µl/year, P = 0.01 respectively. The prevalence of a sub-optimal vitamin B-12 was high in this HIV-infected, ART-naïve adult clinic population in urban Uganda. We recommend prospective studies to further clarify the causal relationships of sub-optimal vitamin B-12, and explore the role of vitamin B-12 supplementation in immune recovery

Understanding data and information needs for palliative cancer care to inform digital health intervention development in Nigeria, Uganda and Zimbabwe: protocol for a multicountry qualitative study

Introduction: Palliative care is a clinically and cost‐effective component of cancer services in sub-Saharan Africa (SSA). Despite the significant need for palliative cancer care in SSA, coverage remains inadequate. The exploration of digital health approaches could support increases in the quality and reach of palliative cancer care services in SSA. However, there is currently a lack of any theoretical underpinning or data to understand stakeholder drivers for digital health components in this context. This project addresses this gap through engaging with key stakeholders to determine data and information needs that could be supported through digital health interventions. Methods and analysis: This is a multicountry, cross-sectional, qualitative study conducted in Nigeria, Uganda and Zimbabwe. In-depth interviews will be conducted in patients with advanced cancer (n=20), caregivers (n=15), health professionals (n=20) and policy-makers (n=10) in each of the three participating countries. Data from a total of 195 interviews will transcribed verbatim and translated into English before being imported into NVivo software for deductive framework analysis. The analysis will seek to understand the acceptability and define mechanisms of patient-level data capture and usage via digital technologies. Ethics and dissemination: Ethics approvals have been obtained from the Institutional Review Boards of University of Leeds (Ref: MREC 18–032), Research Council of Zimbabwe (Ref: 03507), Medical Research Council of Zimbabwe (Ref: MRCZ/A/2421), Uganda Cancer Institute (Ref: 19–2018), Uganda National Council of Science and Technology (Ref: HS325ES) and College of Medicine University of Lagos (Ref: HREC/15/04/2015). The project seeks to determine optimal mechanisms for the design and development of subsequent digital health interventions to support development, access to, and delivery of palliative cancer care in SSA. Dissemination of these findings will occur through newsletters and press releases, conference presentations, peer-reviewed journals and social media. Trial registration number: ISRCTN1572771

A qualitative evaluation of the impact of a palliative care course on preregistration nursing students' practice in Cameroon

Background Current evidence suggests that palliative care education can improve preregistration nursing students’ competencies in palliative care. However, it is not known whether these competencies are translated into students’ practice in the care of patients who are approaching the end of life. This paper seeks to contribute to the palliative care evidence base by examining how nursing students in receipt of education report transfer of learning to practice, and what the barriers and facilitators may be, in a resource-poor country. Methods We utilised focus groups and individual critical incident interviews to explore nursing students’ palliative care learning transfer. Three focus groups, consisting of 23 participants and 10 individual critical incident interviews were conducted with preregistration nursing student who had attended a palliative care course in Cameroon and had experience caring for a patient approaching the end of life. Data was analysed thematically, using the framework approach. Results The results suggest that nursing students in receipt of palliative care education can transfer their learning to practice. Students reported recognizing patients with palliative care needs, providing patients with physical, psychosocial and spiritual support and communicating patient information to the wider care team. They did however perceive some barriers to this transfer which were either related to themselves, qualified nurses, the practice setting or family caregivers and patients. Conclusion The findings from this study suggest that nursing student in receipt of palliative care education can use their learning in practice to provide care to patients and their families approaching the end of life. Nevertheless, these findings need to be treated with some caution given the self-reported nature of the data. Demonstrating the link between preregistration palliative care education and patient care is vital to ensuring that newly acquired knowledge and skills are translated and embedded into clinical practice. This study also has implications for advocating for palliative care policies and adequately preparing clinical placement sites for students’ learning and transfer of learning

Digital clubbing in tuberculosis – relationship to HIV infection, extent of disease and hypoalbuminemia

BACKGROUND: Digital clubbing is a sign of chest disease known since the time of Hippocrates. Its association with tuberculosis (TB) has not been well studied, particularly in Africa where TB is common. The prevalence of clubbing in patients with pulmonary TB and its association with Human Immunodeficiency Virus (HIV), severity of disease, and nutritional status was assessed. METHODS: A cross-sectional study was carried out among patients with smear-positive TB recruited consecutively from the medical and TB wards and outpatient clinics at a public hospital in Uganda. The presence of clubbing was assessed by clinical signs and measurement of the ratio of the distal and inter-phalangeal diameters (DPD/IPD) of both index fingers. Clubbing was defined as a ratio > 1.0. Chest radiograph, serum albumin and HIV testing were done. RESULTS: Two hundred patients (82% HIV-infected) participated; 34% had clubbing by clinical criteria whilst 30% had clubbing based on DPD/IPD ratio. Smear grade, extensive or cavitary disease, early versus late HIV disease, and hypoalbuminemia were not associated with clubbing. Clubbing was more common among patients with a lower Karnofsky performance scale score or with prior TB. CONCLUSION: Clubbing occurs in up to one-third of Ugandan patients with pulmonary TB. Clubbing was not associated with stage of HIV infection, extensive disease or hypoalbuminemia