Predictors of short birth interval among women of reproductive age attending the young child clinic at a tertiary hospital in Western Uganda: a cross-section study

Background: Short birth interval continues to increase in sub-Sahara Africa of which Uganda is part. If all birth-to-pregnancy intervals were spaced at least 2 years apart as recommended by the world health organization, most under-five deaths would be avoided. We aim at determining the predictors of short birth interval among women of reproductive age at tertiary hospitals, Uganda. Methods: A cross-sectional study involving 325 women of reproductive age attending the young child clinic at Fortportal Regional Referral Hospital was conducted from July 2022 to October 2022. Interviewer-administered questionnaires were used to obtain data used for analysis. Descriptive statistics followed by binary logistic regression were conducted to achieve the study objectives using SPSS version 22.0. Results: Out of 325 participants, 94 (29%) had short birth interval. Maternal age (OR=3.4, 95% CI: 1.15-10.13; p=0.02), no previous pregnancy planning (OR=3.4, 95% CI: 1.23-9.41; p=0.01), duration of breastfeeding less than 12 months (OR=1.9, 95% CI: 0.06-0.58; p=0.003), less or equal to 4 antenatal care visits (OR=8.7, 95% CI: 3.19-23.80; p≤0.001) and not using postpartum contraceptives (OR=5.7, 95% CI: 1.64-19.81; p=0.006) were independently associated with short birth interval. Conclusions: The prevalence of short birth interval is still high in Uganda as compared to global report. The predictor factors of short birth interval include maternal lack of pregnancy planning, low number of antenatal care visits, breastfeeding for less than 12 months and lack of postpartum contraceptive use. Women of reproductive age should routinely be educated about child spacing by healthcare workers

Coitus induced colpo evisceration in a 3-months post hysterectomy patient: an unusual tale in gynecology

Vaginal dehiscence after pelvic surgery is an extremely rare gynecological emergency world over. Without a high index of suspicion, it can easily be missed with grave consequences. We present an extremely rare case of this post abdominal hysterectomy case for which if immediate suspicion and timely intervention were not ensured, the patient would have suffered serious morbidity and/or death

Can a Respiratory Severity Score Accurately Assess Respiratory Distress in Children with Bronchiolitis in a Resource-Limited Setting?

You are the resident on call for the acute pediatric ward in a district hospital in a resource-limited setting. A 9-month-old male infant presents with a 3-day history of coryza and cough followed by difficulty in breathing. The infant is admitted to the acute ward for observation but does not need supplementary oxygen or fluid support. During the ward-round it was felt that his condition at presentation did not warrant admission. You are concerned that by being admitted unnecessarily this infant was put at an unnecessary risk of nosocomial infection. Furthermore, the care is paid for by the family and bed spaces are lacking. You wonder if there is a valid and reliable respiratory distress severity score that may help to accurately assess respiratory distress as a useful adjunct for clinical decision making, to help reduce unnecessary admissions in children with bronchiolitis

Long-lasting insecticidal net source, ownership and use in the context of universal coverage: a household survey in eastern Rwanda

Contains fulltext : 162707.pdf (publisher's version ) (Open Access)BACKGROUND: Universal long-lasting insecticidal net (LLIN) coverage (ULC) has reduced malaria morbidity and mortality across Africa. Although information is available on bed net use in specific groups, such as pregnant women and children under 5 years, there is paucity of data on their use among the general population. Bed net source, ownership and determinants of use among individuals from households in an eastern Rwanda community 8 months after a ULC were characterized. METHODS: Using household-based, interviewer-administered questionnaires and interviewer-direct observations, data on bed net source, ownership and key determinants of net use, including demographics, socio-economic status indicators, house structure characteristics, as well as of bed net quantity, type and integrity, were collected from 1400 randomly selected households. Univariate and mixed effects logistic regression modelling was done to assess for determinants of bed net use. RESULTS: A total of 1410 households and 6598 individuals were included in the study. Overall, the proportion of households with at least one net was 92 % while bed net usage was reported among 72 % of household members. Of the households surveyed, a total ownership of 2768 nets was reported, of which about 96 % were reportedly LLINs received from the ULC. By interviewer-physical observation, 88 % of the nets owned were of the LLIN type with the remaining 12 % did not carry any mark to enable type recognition. The odds of bed net use were significantly lower among males and individuals: from households of low socio-economic status, from households with /=two sleeping spaces, and those reporting to have not slept on a bed. CONCLUSION: In this study, despite high a bed net coverage, over 25 % of members reported not to have slept under a bed net the night before the survey. Males were particularly less likely to use bed nets even where nets were available. Household socio-economic status, number of bed nets and type and number of sleeping spaces were key determinants of bed net use. To maximize impact of ULC, strategies that target males as well as those that ensure ITN coverage for all, address barriers to feasible and convenient bed net use including covering over all sleeping space types, and provide net hanging supports, are needed.10 p

Assessment of aflatoxin and fumonisin contamination levels in maize and mycotoxins awareness and risk factors in Rwanda

Mycotoxins are secondary metabolites of fungi that are toxic to humans and animals when consumed in contaminated food and feed. The Rwandan climate conditions like steady temperature and sufficient rainfall favor the growth of fungi leading to high probability of mycotoxins contamination. Mycotoxins get into maize throughout the value chain from the field to processed products. Maize is  promoted in Rwanda under the Crop Intensification Program (CIP), for nutrition and food security. The aim of the study was to evaluate mycotoxins (Aflatoxin and fumonisin) levels in maize and assess awareness and factors associated with mycotoxin contamination in Rwanda. Maize samples (227 kg) from season B 2019 were collected in 15 Districts in five provinces of Rwanda after an interview with a representative of the household or cooperative using a structured questionnaire. The samples were analyzed for aflatoxin and  fumonisin using Reveal Q+ and AccuScan Gold Reader. From the interview, most of the respondents were not aware about aflatoxin (59.7 %) and 99 % did not know the effect of mycotoxins on human health. The average of aflatoxin contamination in surveyed districts was 6.69±13 μg/kg. In general, 90.4 % of samples scored below the limit of aflatoxin level regulated in East Africa/Kenya regulation standards (10 μg/kg). The levels of aflatoxin ranged between 0 and 100.9 μg/kg. The means aflatoxin levels within districts ranged between 1.36±0.5 μg/kg and 13.75±25 μg/kg. Among 9.6 % of the samples containing aflatoxins above the EU and Kenyan regulations standard limit, 5.7 % were above the US standards of 20 μg/kg. Within clusters, the level of aflatoxin more than 10 μg/kg was 5 %, 7 % and 18 % for stores, household and market samples, respectively. From the study, as mechanical damage of grains, moisture content of grains and the temperature of the store house increased, Aflatoxin level also increased. Fumonisin analyzed in maize ranged from 0 to 2.3 μg/g and only one sample from market showed a slightly higher level of fumonisin than the EU and US limit of 2 μg/g. More effort for aflatoxin mitigation is needed at the market level. Farmers need to be aware and taught how they can improve their agricultural system and more knowledge on mycotoxin control is needed. The results point to appropriate measures to recommend for control ofmycotoxins in Rwanda and awareness creation. Key words: AccuScan, Aflatoxin, Fumonisin, Fungal, Maize, Mycotoxins, Reveal Q+, Rwand

Lipids modulate the conformational dynamics of a secondary multidrug transporter

Direct interactions with lipids have emerged as key determinants of the folding, structure and function of membrane proteins, but an understanding of how lipids modulate protein dynamics is still lacking. Here, we systematically explored the effects of lipids on the conformational dynamics of the proton-powered multidrug transporter LmrP from Lactococcus lactis, using the pattern of distances between spin-label pairs previously shown to report on alternating access of the protein. We uncovered, at the molecular level, how the lipid headgroups shape the conformational-energy landscape of the transporter. The model emerging from our data suggests a direct interaction between lipid headgroups and a conserved motif of charged residues that control the conformational equilibrium through an interplay of electrostatic interactions within the protein. Together, our data lay the foundation for a comprehensive model of secondary multidrug transport in lipid bilayers

High aboveground carbon stock of African tropical montane forests

Tropical forests store 40–50 per cent of terrestrial vegetation carbon1. However, spatial variations in aboveground live tree biomass carbon (AGC) stocks remain poorly understood, in particular in tropical montane forests2. Owing to climatic and soil changes with increasing elevation3, AGC stocks are lower in tropical montane forests compared with lowland forests2. Here we assemble and analyse a dataset of structurally intact old-growth forests (AfriMont) spanning 44 montane sites in 12 African countries. We find that montane sites in the AfriMont plot network have a mean AGC stock of 149.4 megagrams of carbon per hectare (95% confidence interval 137.1–164.2), which is comparable to lowland forests in the African Tropical Rainforest Observation Network4 and about 70 per cent and 32 per cent higher than averages from plot networks in montane2,5,6 and lowland7 forests in the Neotropics, respectively. Notably, our results are two-thirds higher than the Intergovernmental Panel on Climate Change default values for these forests in Africa8. We find that the low stem density and high abundance of large trees of African lowland forests4 is mirrored in the montane forests sampled. This carbon store is endangered: we estimate that 0.8 million hectares of old-growth African montane forest have been lost since 2000. We provide country-specific montane forest AGC stock estimates modelled from our plot network to help to guide forest conservation and reforestation interventions. Our findings highlight the need for conserving these biodiverse9,10 and carbon-rich ecosystems