Prevalence, clinical presentation and factors associated with Uterine fibroids among women attending the Gynecology Outpatient Department at a large Referral Hospital in Southwestern Uganda

Background: Uterine fibroids are the most common benign female gynecologic tumors. There are multiple risk factors, including age and reduced fertility. There is however a paucity of data on disease burden and risk factors among African populations.Objective: We determined the prevalence, clinical presentation and factors associated with uterine fibroids among women at Mbarara hospital gynecology clinic, Uganda.Methods: We conducted a cross sectional study from November 2018 to February 2019 on 319 women attending gynecology clinic. An abdomino-pelvic ultrasound scan was performed on each participant and data analyzed using Stata Version 13. Multivariable logistic regression was used to determine association between selected characteristics and uterine fibroid appearance. P value of less than 0.05 was interpreted as significant.Results: The number of women with fibroids was 90 out of 319, representing a prevalence of uterine fibroids of 28.2%. About 67 (74.4%) of the participants with fibroids were symptomatic having pelvic pain 65 (72.2%), menorrhagia 57 (63.3%), pelvic mass 20 (22.2%) and failure to conceive 9 (10%). Women in age group of 31 – 50 years (adjusted OR 4.2; 95% CI,2.0 to 8.5), those separated from their spouses (adjusted OR 4.4; 95% CI,1.8 to 10.5), overweight (adjusted OR 4.9; 95% CI, 2.6 to 9.6), obesity (adjusted OR 4.1; 95% CI,1.6 to 10.5) were more likely to be diagnosed with uterine fibroids while delayed menarche (adjusted OR 0.4; 95% CI, 0.1 to 0.8) was protective.Conclusion: The study found the prevalence of uterine fibroids to be high. Majority of patients were symptomatic at presentation with pelvic pain, menorrhagia, irregular menses and pelvic mass. Uterine fibroids cause significant morbidity among reproductive age women. The identified risk factors included overweight and age group of 31 to 50 years. We recommend Ultrasound scan in women of reproductive age attending gynecology clinic to detect uterine fibroids early in order to manage them promptly so as to prevent the associated complications

Financial Intermediation by Microfinance Banks in Rural Sub-Saharan Africa: Financial Intermediation Theoretical Approach

Premised on Meta analysis of financial intermediation theory by Gurley and Shaw (1960), Leland and Pyle (1977), Diamond and Dybvig (1983), Allen and Santomero (1996), Scholtens and van Wensveen (2000), the main purpose of this study is to test for the predictive power of each of the dimensions of financial intermediation of market penetration and quality of financial services on financial inclusion of the poor by microfinance banks in rural sub-Saharan Africa grounded on the financial intermediation theory. This study adopted a cross-sectional research design and data were collected from 400 poor households located in rural Uganda. The data were analyzed using ordinary least square hierarchical regression (OLS) in SPSS (statistical packages for social sciences) to generate the explanatory power of each of the dimensions of financial intermediation on financial inclusion based on coefficient of determination (R²). In addition, results from analysis of variances (ANOVA) were also generated to establish the differences in the perceptions of the poor towards being financially included through financial intermediation. The results revealed that market penetration and quality of financial services as dimensions of financial intermediation significantly explains 22 percent of the variation in financial inclusion of the poor in rural Uganda. Additionally, when individual effects were considered, both market penetration and quality of financial services had significant and positive effects on financial inclusion of the poor in rural Uganda. Accordingly, our study contributes and recommends specific policies toward the role of financial intermediaries in financial deepening, especially in rural sub-Saharan Africa where there are limited presence of traditional banking structures to serve the unbanked rural poor households

Healthy Heart Africa-Kenya: A 12-Month Prospective Evaluation of Program Impact on Health Care Providers\u27 Knowledge and Treatment of Hypertension

Background: Given the rising burden of hypertension in Africa, the Healthy Heart Africa program was developed to improve access to quality hypertension care in the primary care setting. The Healthy Heart Africa program provides a comprehensive, coordinated intervention directed at health care providers (HCPs) and the general public. Objective: The impact of Healthy Heart Africa on HCPs\u27 knowledge of hypertension and facility-level services in Kenya was evaluated by a 12-month prospective study. Methods: Intervention facilities were selected by stratified random sampling and matched to similar control facilities. Intervention facilities received a hypertension treatment protocol, equipment, training and patient education materials, and improved medical supply chain, whereas control facilities did not. HCPs responsible for hypertension care were surveyed at baseline and 12 months later. Hypertension screening and treatment data were abstracted from service delivery registers. A differences-in-differences analysis estimated the impact of Healthy Heart Africa on HCPs\u27 knowledge, hypertension services, and the number of patients diagnosed with and seeking treatment for hypertension. Results: Sixty-six intervention and 66 control facilities were surveyed. Healthy Heart Africa improved HCPs\u27 knowledge of ≥5 hypertension risk factors and ≥5 methods for reducing/managing hypertension but not hypertension consequences. At end line, more intervention than control facilities measured blood pressure more than once during the same visit to diagnose hypertension, dedicated days to hypertension care, used posters to increase hypertension awareness, and provided access to hypertension medications. The number of patients diagnosed with hypertension and those seeking treatment for hypertension increased with intervention, but the change was not significant relative to control subjects. Conclusions: HCP-directed hypertension education and provision of basic resources positively influenced hypertension care in Kenya in the first 12 months of implementation

CD4 T cell activation as a predictor for treatment failure in Ugandans with Plasmodium falciparum malaria.

Host immunity plays an important role in response to antimalarial therapy but is poorly understood. To test whether T cell activation is a risk factor for antimalarial treatment failure, we studied CD4(+) and CD8(+) T cell activation in 31 human immunodeficiency virus-negative Ugandan patients 5-37 years of age who were treated for uncomplicated Plasmodium falciparum malaria. Increased CD4(+) T cell activation, as indicated by co-expression of HLA-DR and CD38, was an independent risk factor for treatment failure (hazard ratio = 2.45, 95% confidence interval = 1.02-5.89, P = 0.05) in multivariate analysis controlling for age, baseline temperature, and pre-treatment parasite density. The results provide insight into the role of cellular immunity in response to antimalarial therapy and underscore the need to investigate the mechanisms behind immune activation

Collaborative autoethnography and reclaiming an African episteme: investigating “customary” ownership of natural resources

Collaborative autoethnography can function as a means of reclaiming certain African realities that have been co-opted by colonial epistemes and language. This can be significant in very concrete ways: northern Uganda is suffering a catastrophic loss of tree cover, much of which is taking place on the collective family landholdings that academia and the development sector have categorized as “customary land.” A collaboration by ten members of such landholding families, known as the Acholi Land Lab, explores what “customary ownership” means to them and their relatives, with a view to understanding what may be involved in promoting sustainable domestic use of natural resources, including trees

Information and Communication Technology Adoption and the Growth of Small Medium Enterprises in Uganda: Empirical Evidence from Kampala City Council Authority

The study used cross sectional study design and data were collected from business owners operating within the divisions of Kampala Capital City Authority. The study found out that the level of ICT adoption in Kampala Capital City Authority was moderate. ICT adoption was mostly marked with establishment of separate IT department, use of bulk SMS, printers, scanners and photocopiers. Specialized ICT skills, regular updates and outsourcing of ICT functions appeared to be a key challenge business face in ICT adoption. The findings however, indicated that growth of SMEs is a conglomeration, of which adoption of ICT is a microcosm. The study recommends that Government of Uganda through Ministry of Science Technology and Innovation and Ministry of Finance Planning and Economic Development should consider promoting ICT business growth by sponsoring business software development, and distributing the same at subsidized costs. Training institutions should strengthen the ICT training programs by aligning them to the required job demands as dictated in the field of business. Government should also promote the application and adoption of ICT e-business by slashing the exorbitant taxes charged on the use of these products. Government should stimulate entrepreneurship development training to curb the shortfalls in staff competence, individual job creation and profitability skills

Investigating portable fluorescent microscopy (CyScope®) as an alternative rapid diagnostic test for malaria in children and women of child-bearing age

<p>Abstract</p> <p>Background</p> <p>Prompt and correct diagnosis of malaria is crucial for accurate epidemiological assessment and better case management, and while the gold standard of light microscopy is often available, it requires both expertise and time. Portable fluorescent microscopy using the CyScope^®offers a potentially quicker, easier and more field-applicable alternative. This article reports on the strengths, limitations of this methodology and its diagnostic performance in cross-sectional surveys on young children and women of child-bearing age.</p> <p>Methods</p> <p>552 adults (99% women of child-bearing age) and 980 children (99% ≤ 5 years of age) from rural and peri-urban regions of Ugandan were examined for malaria using light microscopy (Giemsa-stain), a lateral-flow test (Paracheck-Pf^®) and the CyScope^®. Results from the surveys were used to calculate diagnostic performance (sensitivity and specificity) as well as to perform a receiver operating characteristics (ROC) analyses, using light microscopy as the gold-standard.</p> <p>Results</p> <p>Fluorescent microscopy (qualitative reads) showed reduced specificity (<40%), resulting in higher community prevalence levels than those reported by light microscopy, particularly in adults (+180% in adults and +20% in children). Diagnostic sensitivity was 92.1% in adults and 86.7% in children, with an area under the ROC curve of 0.63. Importantly, optimum performance was achieved for higher parasitaemia (>400 parasites/μL blood): sensitivity of 64.2% and specificity of 86.0%. Overall, the diagnostic performance of the CyScope was found inferior to that of Paracheck-Pf^®.</p> <p>Discussion</p> <p>Fluorescent microscopy using the CyScope^®is certainly a field-applicable and relatively affordable solution for malaria diagnoses especially in areas where electrical supplies may be lacking. While it is unlikely to miss higher parasitaemia, its application in cross-sectional community-based studies leads to many false positives (i.e. small fluorescent bodies of presently unknown origin mistaken as malaria parasites). Without recourse to other technologies, arbitration of these false positives is presently equivocal, which could ultimately lead to over-treatment; something that should be further explored in future investigations if the CyScope^®is to be more widely implemented.</p

Long-term field performance of a polyester-based long-lasting insecticidal mosquito net in rural Uganda

<p>Abstract</p> <p>Background</p> <p>In order to evaluate whether criteria for LLIN field performance (phase III) set by the WHO Pesticide Evaluation Scheme are met, first and second generations of one of these products, PermaNet^®, a polyester net using the coating technology were tested.</p> <p>Methods</p> <p>A randomized, double blinded study design was used comparing LLIN to conventionally treated nets and following LLIN for three years under regular household use in rural conditions. Primary outcome measures were deltamethrin residue and bioassay performance (60 minute knock-down and 24 hour mortality after a three minute exposure) using a strain of <it>Anopheles gambiae s.s</it>. sensitive to pyrethroid insecticides.</p> <p>Results</p> <p>Baseline concentration of deltamethrin was within targets for all net types but was rapidly lost in conventionally treated nets and first generation PermaNet^®with median of 0.7 and 2.5 mg/m²after six months respectively. In contrast, second generation PermaNet^®retained insecticide well and had 41.5% of baseline dose after 36 months (28.7 mg/m²). Similarly, vector mortality and knockdown dropped to 18% and 70% respectively for first generation LLIN after six months but remained high (88.5% and 97.8% respectively) for second generation PermaNet^®after 36 months of follow up at which time 90.0% of nets had either a knockdown rate ≥ 95% or mortality rate ≥ 80%.</p> <p>Conclusion</p> <p>Second generation PermaNet^®showed excellent results after three years of field use and fulfilled the WHOPES criteria for LLIN. Loss of insecticide on LLIN using coating technology under field conditions was far more influenced by factors associated with handling rather than washing.</p

Research translation to inform national health policies: learning from multiple perspectives in Uganda

<p>Abstract</p> <p>Background</p> <p>Research and evidence can have an impact on policy and practice, resulting in positive outcomes. However, research translation is a complex, dynamic and non-linear process. Although universities in Africa play a major role in generating research evidence, their strategic approaches to influence health policies and decision making are weak. This study was conducted with the aim of understanding the process of translating research into policy in order to guide the strategic direction of Makerere University College of Health Sciences (MakCHS) and similar institutions in their quest to influence health outcomes nationally and globally.</p> <p>Methods</p> <p>A case study approach using 30 in-depth interviews with stakeholders involved in two HIV prevention research project was purposively selected. The study sought to analyze the research-to-policy discourses for the prevention of mother-to-child transmission (PMTCT) and safe male circumcision (SMC). The analysis sought to identify entry points, strengths and challenges for research-to-policy processes by interviewing three major groups of stakeholders in Uganda – researchers (8), policy makers (12) and media practitioners (12).</p> <p>Results</p> <p>Among the factors that facilitated PMTCT policy uptake and continued implementation were: shared platforms for learning and decision making among stakeholders, implementation pilots to assess feasibility of intervention, the emerging of agencies to undertake operations research and the high visibility of policy benefits to child survival. In contrast, SMC policy processes were stalled for over two years after the findings of the Uganda study was made public. Among other factors, policy makers demanded additional research to assess implementation feasibility of SMC within ordinary health system context. High level leaders also publicly contested the SMC evidence and the underlying values and messages – a situation that reduced the coalition of policy champions.</p> <p>Conclusions</p> <p>This study shows that effective translation of PMTCT and SMC research results demanded a “360 degree” approach to assembling additional evidence to inform the implementation feasibility for these two HIV prevention interventions. MakCHS and similar institutions should prioritize implementation research to guide the policy processes about the feasibility of implementing new and effective innovations (e.g. PMTCT or SMC) at a large scale in contexts that may be different from the research environments.</p