Asymptomatic bacteriuria among pregnant women attending antenatal care at Mbale Hospital, Eastern Uganda.

BACKGROUND: Asymptomatic bacteriuria in pregnancy (ASBP) is associated with adverse pregnancy outcomes such as pyelonephritis, preterm or low birth weight delivery if untreated. The aim of this study was to determine the prevalence of asymptomatic bacteriuria, the isolated bacterial agents, and their antibiotic sensitivity patterns in pregnant women attending antenatal care at Mbale Hospital. METHODS: This was a cross sectional study in which 587 pregnant women with no symptoms and signs of urinary tract infection were recruited from January to March 2019. Mid-stream clean catch urine samples were collected from the women using sterile containers. The urine samples were cultured using standard laboratory methods. The bacterial colonies were identified and antibiotic sensitivity was done using disc diffusion method. Chi squared tests and logistic regression were done to identify factors associated with asymptomatic bacteriuria. A p value < 0.05 was considered statistically significant. RESULTS: Out of the 587 pregnant women, 22 (3.75%) tested positive for asymptomatic bacteriuria. Women aged 20-24 years were less likely to have ASBP when compared to women aged less than 20 years (AOR = 0.14, 95%CI 0.02-0.95, P = 0.004). The most common isolates in descending order were E. coli (n = 13, 46.4%) and S.aureus (n = 9, 32.1%). Among the gram negative isolates, the highest sensitivity was to gentamycin (82.4%) and imipenem (82.4%). The gram positive isolates were sensitive to gentamycin (90.9%) followed by imipenem (81.8%). All the isolates were resistant to sulphamethoxazole with trimethoprim (100%). Multidrug resistance was 82.4% among gram negative isolates and 72.4% among the gram positive isolates. CONCLUSION: There was high resistance to the most commonly used antibiotics. There is need to do urine culture and sensitivity from women with ASBP so as to reduce the associated complications

Cryptosporidiosis among People Living with HIV/AIDS on Highly Active Anti-Retroviral Therapy (HAART) at Mukono Church of Uganda Hospital, Uganda

This study was carried out to estimate the prevalence of cryptosporidiosis among People living with HIV (PLWH) on Highly active antiretroviral therapy (HAART)and relate the prevalence to possession of pets and the immune status of the individual attending ART at Mukono church of Uganda hospital. A cross sectional study was carried out among 232 people living with HIV between June and July, 2014. Interview with questionnaires and document reviews were used to collect data. Stool samples were obtained from each patient and processed using formal-ether concentration method, stained by modified Ziehl-Neelsen staining method and parasites were examined by direct microscopy. Univariate and multivariate analysis were carried out. Level of significancewas set at p-value of 0.05. A total of 232 patients participated in the study. The mean age was 36.0

Lived experiences of caregivers of persons with epilepsy attending an epilepsy clinic at a tertiary hospital, eastern Uganda: A phenomenological approach.

IntroductionEpilepsy has been found to affect caregivers' quality of life, lifestyle, psychological health, social well-being, and working time. Caregivers in Uganda as in the rest of the world are important in assisting a person with epilepsy in complying with medical directions and are actively involved in communicating with healthcare professionals. Little is known about the lived experiences of caregivers of persons afflicted with epilepsy in Uganda. The purpose of this study was to determine the lived experiences of caregivers of persons with epilepsy attending the epilepsy clinic at Mbale regional referral hospital, eastern Uganda.Methods and materialsThe caregivers' lived experiences were elicited directly from them and their health workers who work with them in the care of the patients. Forty participants which consisted of 30 caregivers and 10 key informant health workers were selected for the study through purposive sampling. Face-to-face in-depth interviews with an unstructured interview guide were conducted to gather participants' information. The principal investigator conceptualized the interview guide, the guide was then reviewed by co-investigators, and revised and approved as the final data collection instrument after an extensive and comprehensive literature review. The interview guide comprised two sections; the first section comprised the questions that elicited the participants' social-demographic information. The second section comprised questions that explored caregivers' experiences of persons afflicted with epilepsy. Notations were taken and a digital recorder was used purposely for audio recordings. All interviews lasted for an hour and were audio-recorded with the participant's consent. An inductive thematic analysis was employed and adopted to identify the patterns emerging from the texts.ResultsThe caregivers majorly perceived epilepsy as a burden. Four main themes were revealed from the analysis and these are: psychological burdens which included, worries about the future of the patient, being looked down upon; social burdens which entailed, affected public relations, feelings of stigma; an economic burden which included interference with the source of income, affected productivity at work; and physical burdens which included, Feelings of uneasiness and disrupted sleep among others.ConclusionThe caregivers majorly perceived epilepsy as a serious burden. This burden can be psychological, social, economic, and physical. Therefore, services and plans targeting patients with epilepsy need to consider the burden that caregivers encounter to comprehensively manage epilepsy

Investigating metabolic and molecular ecological evolution of opportunistic pulmonary fungal coinfections: protocol for a laboratory-based cross-sectional study

Background: Fungal-bacterial cocolonization and coinfections pose an emerging challenge among patients suspected of having pulmonary tuberculosis (PTB); however, the underlying pathogenic mechanisms and microbiome interactions are poorly understood. Understanding how environmental microbes, such as fungi and bacteria, coevolve and develop traits to evade host immune responses and resist treatment is critical to controlling opportunistic pulmonary fungal coinfections. In this project, we propose to study the coexistence of fungal and bacterial microbial communities during chronic pulmonary diseases, with a keen interest in underpinning fungal etiological evolution and the predominating interactions that may exist between fungi and bacteria. Objective: This is a protocol for a study aimed at investigating the metabolic and molecular ecological evolution of opportunistic pulmonary fungal coinfections through determining and characterizing the burden, etiological profiles, microbial communities, and interactions established between fungi and bacteria as implicated among patients with presumptive PTB. Methods: This will be a laboratory-based cross-sectional study, with a sample size of 406 participants. From each participant, 2 sputa samples (one on-spot and one early morning) will be collected. These samples will then be analyzed for both fungal and bacterial etiology using conventional metabolic and molecular (intergenic transcribed spacer and 16S ribosomal DNA–based polymerase chain reaction) approaches. We will also attempt to design a genome-scale metabolic model for pulmonary microbial communities to analyze the composition of the entire microbiome (ie, fungi and bacteria) and investigate host-microbial interactions under different patient conditions. This analysis will be based on the interplays of genes (identified by metagenomics) and inferred from amplicon data and metabolites (identified by metabolomics) by analyzing the full data set and using specific computational tools. We will also collect baseline data, including demographic and clinical history, using a patient-reported questionnaire. Altogether, this approach will contribute to a diagnostic-based observational study. The primary outcome will be the overall fungal and bacterial diagnostic profile of the study participants. Other diagnostic factors associated with the etiological profile, such as incidence and prevalence, will also be analyzed using univariate and multivariate schemes. Odds ratios with 95% CIs will be presented with a statistical significance set at P<.05. Results: The study has been approved by the Mbarara University Research Ethic Committee (MUREC1/7-07/09/20) and the Uganda National Council of Science and Technology (HS1233ES). Following careful scrutiny, the protocol was designed to enable patient enrollment, which began in March 2022 at Mbarara University Teaching Hospital. Data collection is ongoing and is expected to be completed by August 2023, and manuscripts will be submitted for publication thereafter. Conclusions: Through this protocol, we will explore the metabolic and molecular ecological evolution of opportunistic pulmonary fungal coinfections among patients with presumptive PTB. Establishing key fungal-bacterial cross-kingdom synergistic relationships is crucial for instituting fungal bacterial coinfecting etiology. Trial Registration: ISRCTN Registry ISRCTN33572982; https://tinyurl.com/caa2nw69 International Registered Report Identifier (IRRID): DERR1-10.2196/48014 JMIR Res Protoc 2023;12:e48014 doi:10.2196/4801

Molecular epidemiology of antimicrobial resistance at a human-animal interface in pastoralist community of Kasese District, Uganda

A thesis submitted to the Directorate of Research and Graduate Training for the award of the Degree of Doctor of Philosophy of Makerere University.Background: Intensive usage of antimicrobials in the management of animal diseases may cause selection for resistance among microorganisms. Transmission of resistant bacteria from the wild and domestic food animals to humans may occur via the food chain, environment, or direct interaction with animals and this may lead to the emergence of infections that are challenging to manage. This study aimed to determine the molecular epidemiology of antimicrobial resistance at a human-animal interface in pastoralist communities of Kasese district. Methods: A mixed-methods cross-sectional study was carried out involving participants presenting with fever and/or diarrhea in the health facilities whose samples were taken for culture and sensitivity. Participants from whom multidrug-resistant bacteria were isolated were back-traced to the community and samples were taken from members of the household. Speciation and antibiotic susceptibility of the isolates was done using the Phoenix automated microbiology system (Phoenix 100 ID/DST system) from Becton and Dickson (Franklin Lakes, NJ, USA) and the results interpreted using the CLSI guidelines Whole-genome paired-end sequencing (WGS) was performed at the facilities of Kenya Medical Research Institute-Wellcome trust, Kilifi for the multidrug-resistant isolates from humans and cattle. In the community, questionnaires were administered to the participants and key informant interviews were conducted. Results: A total of 371 participants were recruited and 122 from whom multi-drug resistant bacteria were isolated were followed up to the community. Overall, high resistance patterns were detected among our isolates with many of the isolates being multi-drug resistant. The general trend of antimicrobial resistance among the Cholera isolates showed increased susceptibility to combination therapy as opposed to monotherapy Phenotypic resistance testing revealed similar resistance patterns among the human and the cattle isolates for the 15 antibiotics tested in this study, however, Phylogenetic analysis showed that the genomes of the human E. coli generally clustered together and away from those of cattle origin. The E. coli isolates were assigned to eight different phylogroups: A, B1, B2, Cladel, D, E, F, and G, with a majority being assigned to phylogroup A; while most of the animal isolates were assigned to phylogroup B1. The carriage of multiple AMR genes was higher from the E. coli population from humans than those from cattle. Among these were Beta-lactamase; blaOXA-1: Class D beta-lactamases; blaTEM-1, blaTEM-235: Beta-lactamase; catA1: chloramphenicol acetyltransferase; cmlA1: chloramphenicol efflux transporter; dfrA1, dfrA12, dfrA14, dfrA15, dfrA17, dfrA5, dfrA7, dfrA8: macrolide phosphotransferase; oqxB11: RND efflux pump conferring resistance to fluoroquinolone; qacL, qacEdelta1: quinolone efflux pump; qnrS1: quinolone resistance gene; sul1, sul2, sul3: sulfonamide resistant; tet(A), tet(B): tetracycline efflux pump. A high variation of virulence genes was registered among the E. coli genomes from humans than those of cattle origin. Carriage of multi-drug resistant bacteria among humans was 88 (93%) and 76(80%) among cattle. Consumption of lakeshore water and carriage of multi-drug resistant bacteria in cattle were associated with carriage of multi-drug resistant bacteria in the human population. The key informants reported that antibiotics were used as first aid both in humans and cattle and no surveillance measures for antimicrobial resistance were put in place. The key informants also associated the problem of antimicrobial resistance to poverty, illiteracy, lack of veterinary personnel, ignorance among the community, and the low-cadre of medical staff serving the community. Conclusion: We demonstrated high antimicrobial resistance in bacteria isolated in humans and animals in pastoralist communities of Kasese district. Consumption of lakeshore water and carriage of multi-drug resistant bacteria in cattle were associated with carriage of multi-drug resistant bacteria in the human population. From the analysis of the core genome and phenotypic resistance, this study has demonstrated that the E. coli of human origin and those of cattle origin may have a common ancestry. Limited sharing of virulence genes presents a challenge to the notion that AMR in humans is as a result of antibiotic use in the farm and distorts the picture of the directionality of transmission of AMR at a human-animal interface and presents a task of exploring alternative routes of transmission of AMR.This work was supported by the DELTAS Africa Initiative [grant# 107743/Z/15/Z]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)'s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa's Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [grant #107743/ Z/15/Z] and the UK government

Bottlenecks and Opportunities towards Achieving the Targeted 95-95-95 HIV Services in a Rural District in Eastern Uganda.

Uganda has made progress in reducing the HIV prevalence from 7.3% in 2011 to 6% in 2017, however, more needs to be done to meet the WHO target of 95% of the population knowing their HIV status, 95% enrolled on treatment and 95% achieving viral suppression. This study aimed to assess the bottlenecks and opportunities towards achieving the 95 95 95 targeted HIV services in Bukedea district.The study revealed that the major challenges towards achieving the targeted 95-95-95 HIV services were stigma, inadequate pre-test counseling, fear of disclosure, and poor adherence due to alcoholism, sharing of drugs with animals and partners. The use of Anti-retroviral drugs in animal husbandry was common in Bukedea District

Bottlenecks and Opportunities towards Achieving the Targeted 95-95-95 HIV Services in a Rural District in Eastern Uganda.

Uganda has made progress in reducing the HIV prevalence from 7.3% in 2011 to 6% in 2017, however, more needs to be done to meet the WHO target of 95% of the population knowing their HIV status, 95% enrolled on treatment and 95% achieving viral suppression. This study aimed to assess the bottlenecks and opportunities towards achieving the 95 95 95 targeted HIV services in Bukedea district.The study revealed that the major challenges towards achieving the targeted 95-95-95 HIV services were stigma, inadequate pre-test counseling, fear of disclosure, and poor adherence due to alcoholism, sharing of drugs with animals and partners. The use of Anti-retroviral drugs in animal husbandry was common in Bukedea District

Sanitation, Hygiene Status, and Carcass Contamination with Escherichia Coli 0157:H7 at Meat Handling Sites in Iganga Municipality

Background: In developing countries, Foodborne infections, particularly those linked to Escherichia coli 0157:H7 contamination, pose significant public health risks. These infections often result from poor hygiene practices in meat handling sites such as abattoirs and butcher shops. Despite interventions aimed at improving sanitation, the prevalence of meat contamination remains high, especially in rural and peri-urban areas like Iganga Municipality, Uganda. This study sought to assess the sanitation and hygiene status of meat handling sites in Iganga Municipality, the level of carcass contamination with E. coli 0157.H7, and the antibiotic susceptibility profile of E. coli 0157:H7