Novel methods for quantitative analysis and evaluation of effects of chronic exposure to microcystins by capillary electrophoresis and metabolomic studies

Ph.DDOCTOR OF PHILOSOPH

Evaluation of persistent organochlorine pesticides and polychlorinated biphenyls in Umgeni River bank soil, KwaZuluNatal, South Africa

is study investigated the presence and distribution of organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) in soil collected along the banks of the Umgeni River, one of the largest rivers in the province of KwaZulu-Natal, South Africa. e analysis was performed using gas chromatography-mass spectrometry (GC-MS). e results showed that the levels of OCPs ranged from 3.58±0.09 ng/g for hexachlorobenzene (HCB) to 82.65±2.82 ng/g for HCH, with an individual mean concentration of 24.33±2.00 ng/g dry weight (dw). e levels of PCBs ranged from 10.46 ng/g for PCB105 to 89.46 ng/g for PCB180, with an average PCB value of 25.47±1.26 ng/g, dw. e highest levels of OCPs and PCBs were found at Northern Wastewater Treatment Plant (mean OCP: 32.39±3.97 ng/g and PCB: 67.87±1.67 ng/g). e two most abundant contaminants in the river were endrin and PCB180.Keywords: Umgeni River, bank soil, OCPs, PCBs, gas chromatography mass spectrometr

Effect of Breastfeeding Promotion on Early Childhood Caries and Breastfeeding Duration among 5 Year Old Children in Eastern Uganda: A Cluster Randomized Trial

Background Although several studies have shown short term health benefits of exclusive breastfeeding (EBF), its long term consequences have not been studied extensively in low-income contexts. This study assessed the impact of an EBF promotion initiative for 6 months on early childhood caries (ECC) and breastfeeding duration in children aged 5 years in Mbale, Eastern Uganda. Methods Participants were recruited from the Ugandan site of the PROMISE- EBF cluster randomised trial (ClinicalTrials.gov no: NCT00397150). A total of 765 pregnant women from 24 clusters were included in the ratio 1:1 to receive peer counselled promotion of EBF as the intervention or standard of care. At the 5 year follow-up, ECC was recorded under field conditions using the World Health Organization’s decayed missing filled tooth (dmft) index. Adjusted negative binomial and linear regression were used in the analysis. Results Mean breastfeeding duration in the intervention and control groups (n=417) were 21.8 (CI 20.7–22.9) and 21.3(CI 20.7–21.9) months, respectively. The mean dmft was 1.5 (standard deviation [SD] 2.9) and 1.7 (SD 2.9) in the intervention and control groups, respectively. Corresponding prevalence estimates of ECC were 38% and 41%. Negative binomial regression analysis adjusted for cluster effects and loss-to-follow-up by inverse probability weights (IPW) showed an incidence-rate ratio (IRR) of 0.91 (95% CI 0.65–1.2). Comparing the effect of the trial arm on breastfeeding duration showed a difference in months of 0.48 (-0.72 to 1.7). Conclusion PROMISE EBF trial did not impact on early childhood caries or breastfeeding duration at 5 years of age. This study contributes to the body of evidence that promotion of exclusive breastfeeding does not raise oral health concerns. However, the high burden of caries calls for efforts to improve the oral health condition in this setting

Exploring the effect of implementation and context on a stepped-wedge randomised controlled trial of a vital sign triage device in routine maternity care in low-resource settings

© 2019 The Author(s). Background: Interventions aimed at reducing maternal mortality are increasingly complex. Understanding how complex interventions are delivered, to whom, and how they work is key in ensuring their rapid scale-up. We delivered a vital signs triage intervention into routine maternity care in eight low- and middle-income countries with the aim of reducing a composite outcome of morbidity and mortality. This was a pragmatic, hybrid effectiveness-implementation stepped-wedge randomised controlled trial. In this study, we present the results of the mixed-methods process evaluation. The aim was to describe implementation and local context and integrate results to determine whether differences in the effect of the intervention across sites could be explained. Methods: The duration and content of implementation, uptake of the intervention and its impact on clinical management were recorded. These were integrated with interviews (n = 36) and focus groups (n = 19) at 3 months and 6-9 months after implementation. In order to determine the effect of implementation on effectiveness, measures were ranked and averaged across implementation domains to create a composite implementation strength score and then correlated with the primary outcome. Results: Overall, 61.1% (n = 2747) of health care providers were trained in the intervention (range 16.5% to 89.2%) over a mean of 10.8 days. Uptake and acceptability of the intervention was good. All clusters demonstrated improved availability of vital signs equipment. There was an increase in the proportion of women having their blood pressure measured in pregnancy following the intervention (79.2% vs. 97.6%; OR 1.30 (1.29-1.31)) and no significant change in referral rates (3.7% vs. 4.4% OR 0.89; (0.39-2.05)). Availability of resources and acceptable, effective referral systems influenced health care provider interaction with the intervention. There was no correlation between process measures within or between domains, or between the composite score and the primary outcome. Conclusions: This process evaluation has successfully described the quantity and quality of implementation. Variation in implementation and context did not explain differences in the effectiveness of the intervention on maternal mortality and morbidity. We suggest future trials should prioritise in-depth evaluation of local context and clinical pathways. Trial registration: Trial registration: ISRCTN41244132. Registered on 2 Feb 2016

Whether weather matters: Evidence of association between in utero meteorological exposures and foetal growth among Indigenous and non-Indigenous mothers in rural Uganda

Pregnancy and birth outcomes have been found to be sensitive to meteorological variation, yet few studies explore this relationship in sub-Saharan Africa where infant mortality rates are the highest in the world. We address this research gap by examining the association between meteorological factors and birth weight in a rural population in southwestern Uganda. Our study included hospital birth records (n = 3197) from 2012 to 2015, for which we extracted meteorological exposure data for the three trimesters preceding each birth. We used linear regression, controlling for key covariates, to estimate the timing, strength, and direction of meteorological effects on birth weight. Our results indicated that precipitation during the third trimester had a positive association with birth weight, with more frequent days of precipitation associated with higher birth weight: we observed a 3.1g (95% CI: 1.0–5.3g) increase in birth weight per additional day of exposure to rainfall over 5mm. Increases in average daily temperature during the third trimester were also associated with birth weight, with an increase of 41.8g (95% CI: 0.6–82.9g) per additional degree Celsius. When the sample was stratified by season of birth, only infants born between June and November experienced a significant associated between meteorological exposures and birth weight. The association of meteorological variation with foetal growth seemed to differ by ethnicity; effect sizes of meteorological were greater among an Indigenous subset of the population, in particular for variation in temperature. Effects in all populations in this study are higher than estimates of the African continental average, highlighting the heterogeneity in the vulnerability of infant health to meteorological variation in different contexts. Our results indicate that while there is an association between meteorological variation and birth weight, the magnitude of these associations may vary across ethnic groups with differential socioeconomic resources, with implications for interventions to reduce these gradients and offset the health impacts predicted under climate change

Continental concerted efforts to control the seventh outbreak of Ebola Virus Disease in Uganda: the first 90 days of the response

On 20th September 2022, Uganda declared the 7th outbreak of Ebola virus disease (EVD) caused by the Sudan Ebola strain following the confirmation of a case admitted at Mubende Regional Referral Hospital. Upon confirmation, the Government of Uganda immediately activated the national incident management system to initiate response activities. Additionally, a multi-country emergency stakeholder meeting was held in Kampala; convening Ministers of Health from neighbouring Member States to undertake cross-border preparedness and response actions. The outbreak spanned 69 days and recorded a total of 164 cases (142 confirmed, 22 probable), 87 recoveries and 77 deaths (case fatality ratio of 47%). Nine out of 136 districts were affected with transmission taking place in 5 districts but spilling over in 4 districts without secondary transmission. As part of the response the Government was able to galvanise robust community mobilisation and initiated assessment of medical counter measures including therapeutics, new diagnostics and vaccines. This paper highlights the response actions put in place that contributed to the containment of this outbreak in addition to the challenges faced with a special focus on key recommendations for better control of future outbreaks

Mapping the medical outcomes study HIV health survey (MOS-HIV) to the EuroQoL 5 Dimension (EQ-5D-3L) utility index

10.1186/s12955-019-1135-8Health and Quality of Life Outcomes1718

Evaluation of persistent organochlorine pesticides and polychlorinated biphenyls in Umgeni River bank soil, KwaZulu-Natal, South Africa

This study investigated the presence and distribution of organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) in soil collected along the banks of the Umgeni River, one of the largest rivers in the province of KwaZulu-Natal, South Africa. The analysis was performed using gas chromatography-mass spectrometry (GC-MS). The results showed that the levels of OCPs ranged from 3.58±0.09 ng/g for hexachlorobenzene (HCB) to 82.65±2.82 ng/g for HCH, with an individual mean concentration of 24.33±2.00 ng/g dry weight (dw). The levels of PCBs ranged from 10.46 ng/g for PCB105 to 89.46 ng/g for PCB180, with an average PCB value of 25.47±1.26 ng/g, dw. The highest levels of OCPs and PCBs were found at Northern Wastewater Treatment Plant (mean OCP: 32.39±3.97 ng/g and PCB: 67.87±1.67 ng/g). The two most abundant contaminants in the river were endrin and PCB180

Target, Suspect and Non-Target Screening of Silylated Derivatives of Polar Compounds Based on Single Ion Monitoring GC-MS

There is growing interest in determining the unidentified peaks within a sample spectra besides the analytes of interest. Availability of reference standards and hyphenated instruments has been a key and limiting factor in the rapid determination of emerging pollutants in the environment. In this work, polar compounds were silylated and analyzed with gas chromatography mass spectrometry (GC-MS) to determine the abundant fragments within the single ion monitoring (SIM) mode and methodology. Detection limits and recoveries of the compounds were established in river water, wastewater, biosolid and sediment matrices. Then, specific types of polar compounds that are classified as emerging contaminants, pharmaceuticals and personal care products, in the environment were targeted in the Mgeni and Msunduzi Rivers. We also performed suspect and non-target analysis screening to identify several other polar compounds in these rivers. A total of 12 compounds were quantified out of approximately 50 detected emerging contaminants in the Mgeni and Msunduzi Rivers. This study is significant for Africa, where the studies of emerging contaminants are limited and not usually prioritized