An accident waiting to happen? Exposing the potential of urogenital schistosomiasis transmission in the Lake Albert region, Uganda

Abstract Background Urogenital schistosomiasis caused by the parasitic blood fluke Schistosoma haematobium is the most common form of that constitutes a majority of over 240 million schistosomiasis cases. The enigmatic absence of urogenital schistosomiasis in Uganda has, until now, been attributed to the absence of substantial populations of suitable snail intermediate hosts. Methods Malacological surveys were carried out in 73 sites southeast of Lake Albert, Uganda in October and November 2020. Collected snails were transported to the laboratory for identification. The snails were identified using partial mitochondrial cytochrome c oxidase subunit one and nuclear internal transcribed spacer barcoding. Schistosome infections in snails were also assessed using cercarial shedding and rapid diagnostic PCR techniques. Results We found Bulinus globosus and Bulinus nasutus productus, the main intermediate species in the transmission of S. haematobium in mainland East Africa. In this survey, B. globosus was more common than B. nasutus productus, with the former reported at four sites (total count = 188) and the latter reported at one site (total count = 79). Molecular testing revealed a high prevalence of Schistosoma bovis in B. nasutus productus (16%), but no S. haematobium infections were found. Conclusions Given the abundance of snail hosts and the risky human water contact behaviours observed, we highlight the potential for urogenital schistosomiasis transmission in the region. Graphical Abstrac

Household food production is positively associated with dietary diversity and intake of nutrient-dense foods for older preschool children in poorer families: Results from a nationally-representative survey in Nepal.

Nutrition-sensitive interventions supporting enhanced household food production have potential to improve child dietary quality. However, heterogeneity in market access may cause systematic differences in program effectiveness depending on household wealth and child age. Identifying these effect modifiers can help development agencies specify and target their interventions.This study investigates mediating effects of household wealth and child age on links between farm production and child diets, as measured by production and intake of nutrient-dense food groups.Two rounds (2013 and 2014) of nationally representative survey data (n = 5,978 observations) were used to measure production and children's dietary intake, as well as a household wealth index and control variables, including breastfeeding. Novel steps used include measuring production diversity in terms of both species grown and food groups grown, as well as testing for mediating effects of family wealth and age of child.We find significant associations between child dietary diversity and agricultural diversity in terms of diversity of food groups and of species grown, especially for older children in poorer households, and particularly for fruits and vegetables, dairy and eggs. With each additional food group produced, log-odds of meeting minimum dietary diversity score (≥4) increase by 0.25 (p = 0.01) for children aged 24-59 months. For younger children aged 18-23 months there is a similar effect size but only in the poorest two quintiles of household wealth, and for infants 6-18 months we find no correlation between production and intake in most models.Child dietary intake is associated with the composition of farm production, most evident among older preschool children and in poorer households. To improve the nutrition of infants, other interventions are needed; and for relatively wealthier households, own farm production may displace market purchases, which could attenuate the impact of household production on child diets

Prenatal dietary diversity may influence underweight in infants in a Ugandan birth‐cohort

Abstract Growth faltering in early childhood is prevalent in many low resource countries. Poor maternal dietary diversity during pregnancy has been linked with increased risk of fetal growth failure and adverse birth outcomes but may also influence subsequent infant growth. Our aim is to assess the role of prenatal maternal dietary diversity in infant growth in rural Uganda. Data from 3291 women and infant pairs enrolled in a birth cohort from 2014 to 2016 were analysed (NCT04233944). Maternal diets were assessed using dietary recall in the second or third trimesters of pregnancy. Maternal dietary diversity scores (DDS) were calculated using the FAO Minimum Dietary Diversity for Women (MDD‐W). Cox regression models were used to evaluate associations of the DDS with the incidence of underweight, stunting and wasting in infants from 3 to 12 months, adjusting for confounding factors. The median DDS for women was low, at 3.0 (interquartile range 3.0–4.0), relative to the threshold of consuming five or more food groups daily. Infants of women in highest quartile of DDS (diverse diets) were less likely to be underweight (adjusted hazard ratio: 0.70, 95% confidence interval: 0.61, 0.80) compared with infants of women in Quartile 1 (p for trend <0.001) in models controlling for maternal factors. There was no significant association between DDS and stunting or wasting. Our findings suggest a relationship between higher maternal dietary diversity and lower risk of underweight in infancy. These findings suggest that programmes to improve infant growth could additionally consider strengthening prenatal dietary diversity to improve child outcomes globally

Comparison data for freshwater snails hosts of bilharzia and liver flukes collected by citizen scientists and an expert in the Lake Albert region of Uganda

This data was generated in the ATRAP (Action Towards Reducing Aquatic Snail-borne Parasitic diseases) project in western Uganda. ATRAP employed a novel citizen science project in monitoring snail intermediate hosts of Schistosoma and Fasciola flukes that affect human and livestock health. Twenty-five citizen scientists monitored over 76 sites and reported weekly data on snail presence and human activities at the sites. To validate the quality of weekly data collected by citizens, an expert scientist monitored monthly the same sites using the same protocol used by the citizens.This dataset is a subset of the data consisting of matched data per site not more than seven days apart between the expert and citizen sampling. This data was used for analysis in the comparison of data quality of the citizen scientists using expert data as a yardstick.</p

Diet diversity and agricultural diversity quintile produced by child's age (unbalanced panel).

<p>Diet diversity and agricultural diversity quintile produced by child's age (unbalanced panel).</p

Dietary diversity in farm vs. non-farm households by child's age.

<p>Dietary diversity in farm vs. non-farm households by child's age.</p

Household meat production and consumption.

<p>Household meat production and consumption.</p

Household legumes production and consumption.

<p>Household legumes production and consumption.</p

Household fruit and vegetable production and consumption.

<p>Household fruit and vegetable production and consumption.</p

Child dietary diversity by child age (in month).

<p>Box plots show median, 25^th and 75^th percentile of distributions, and diamonds represent mean for each age range.</p