Contribution of street food to dietary intake of habitual urban consumers: a cross-sectional study in Kampala city, Uganda

Background: Street food has continued to be a popular food source in the urban settings of developing countries and is proving to be a vital urban dietary source. However, its dietary contribution among urban populations is yet to be comprehensively understood. Aim: To assess how street food contributes to the dietary intake of habitual street food consumers. Methods: We conducted a community-based cross-sectional study among habitual street food consumers in Kampala city. We defined habitual intake as consumption of a serving of any street food for ≥2 days/week regardless of the food group and number of times it was consumed in a particular day. Questionnaires were used to capture quantitative data on sociodemographic characteristics, anthropometry, 24-hour diet intake and 2-month street food consumption frequency. The Nutritics® diet analysis software version 4.3 and STATA version 13.0 were used for nutrient and statistical analyses respectively. Results: Street food contributed considerably to the daily intake of fat (49.1%), sodium (38.4%) and calcium (36.5%) and least towards the daily intake of vitamin A (11.3%). The majority of consumers opted for street food at breakfast (50%) whereas lunch and snacks featured the least for overall street food inclusion (all 20%). Overall, men demonstrated more dietary intake and inclusion at meals from street food than women. Conclusions: This study indicates a significant contribution of street food for urban consumers but men derive more benefit than women in terms of nutrient intake and inclusion of street food in meals

Role of Cytokines in Trypanosoma brucei-Induced Anaemia: A Review of the Literature

Background: Anaemia is an important complication of trypanosomiasis. The mechanisms through which trypanosomal infection leads to anaemia are poorly defined. A number of studies have implicated inflammatory cytokines, but these data are limited and inconsistent. In this article, we reviewed the published literature on cytokines associated with Trypanosoma brucei infections and their role in the immunopathology leading to anaemia.Methodology: Articles were searched in PubMed through screening of titles and abstracts with no limitation on date of publishing and study design. Articles in English were searched using keywords “African trypanosomiasis”, “sleeping sickness”, “Trypanosoma brucei”, in all possible combinations with “anaemia” and/or “cytokines”.Results: Twelve articles examining cytokines and their role in trypanosomeinduced anaemia were identified out of 1095 originally retrieved from PubMed. None of the articles identified were from human-based studies. A total of eight cytokines were implicated, with four cytokines (IFN-γ, IL-10, TNF-α, IL-12) showing an association with anaemia. These articles reported that mice lacking TNF-α were able to control anaemia, and that IFN-γ was linked to severe anaemia given its capacity to suppress erythropoiesis, while IL-10 was shown to regulate IFN-γ and TNF-α, providing a balance that was associated with severity of anaemia. IFN-γ and TNF-α have also been reported to work in concert with other factors such as nitric oxide and iron in order to induce anaemia.Conclusion: IFN-γ, IL-10, and TNF-α were the three major cytokines identified to beheavily involved in anaemia caused by Trypanosoma brucei infection. The anti-inflammatory cytokine, IL-10, was shown to counter the effects of proinflammatory cytokines in order to balance the severity of anaemia. The mechanism of anaemia is multifactorial and therefore requires further, more elaborate research. Data from human subjects would also shed more light

Thirty-day stroke mortality and associated clinical and laboratory factors among adult stroke patients admitted at Mulago hospital (Uganda)

BackgroundAlthough stroke mortality in developing countries is more than 85%, the case fatality in Uganda is not known.ObjectiveWe determined 30 day case fatality, associated clinical and laboratory presentations among adult stroke patients admitted to Mulago Hospital.DesignProspective descriptive studySettingMulago national referral hospital, Kampala, UgandaParticipantsStroke patients presenting from July 2010 to January 2011.InterventionPatients presenting to the accident and emergency with stroke confirmed on brain computerised tomography (CT) scan were recruited consecutively and subsequently transferred to the neurology unit. Selected social demographics, clinical and laboratory presentations were obtained. Supportive care, specific treatment and rehabilitation services were offered to the participants.Main Outcome MeasuresCase fatality rate at 30 daysResultsOut of 150 eligible participants, 17 declined, 133 were enrolled into the study but 5 were lost to follow up. Data from 128 participants were analysed. The mean age was 62.3+15.7 years and 58.0% were females. Ischemic and haemorrhagic stroke contributed 79% and 21% respectively. Majority of participants 97 (76%) had only motor deficits and 78 (61%) had impaired consciousness. More than half of participants had high blood pressure at admission, with diastolic and systolic hypertension among 106 (83%) and 68 (53%) respectively. Forty eight (38%) participants had hyperglycemia, 42 (33%) leucocytosis, 13% elevated low density lipoprotein and 9% high triglycerides. No participant with ischemic stroke presented in time for thrombolysis. The 30 day case fatality was 43.8% and factors independently associated with it were Glasgow coma scale (GCS) < 9 p = 0.001and age 51-60 years P=0.044.Conclusion Thirty-day case fatality was high. Poor prognostic factors were GCS of <9 and age 51-60 years. Early presentation to hospital, intensive management, implementation of treatment guidelines and measures to prevent stroke should be emphasised.Key words: Mortality, Stroke, Uganda

Facility and home based HIV Counseling and Testing: a comparative analysis of uptake of services by rural communities in southwestern Uganda

<p>Abstract</p> <p>Background</p> <p>In Uganda, public human immunodeficiency virus (HIV) Voluntary Counseling and Testing (VCT) services are mainly provided through the facility based model, although the home based approach is being promoted as a strategy for improving access to VCT. However the uptake of VCT varies according to service delivery model and is influenced by a number of factors. The aim of this study therefore, was to compare predictors for uptake of facility and home based VCT in a rural context.</p> <p>Methods</p> <p>A longitudinal study with cross-sectional investigative phases was conducted at two sites (Rugando and Kabingo) in southwestern Uganda between November 2007 (baseline) and March 2008 (follow up). During the baseline visit, facility based VCT was offered at the main health centre in Rugando while home based VCT was offered at the household level in Kabingo and a mixed survey questionnaire administered to the respondents. The results presented in this paper are derived from only the baseline data.</p> <p>Results</p> <p>Nine hundred ninety four (994) respondents were interviewed, of whom 500 received facility based VCT in Rugando and 494 home based VCT in Kabingo during the baseline visit. The respondents had a mean age of 32.2 years (SD 10.9) and were mainly female (68 percent). Clients who received facility based VCT were less likely to be residents of the more rural households (adjusted Odds Ratio (aOR) = 0.14, 95% CI 0.07, 0.22). The clients who received home based VCT were less likely to report having an STI symptom (aOR = 0.63, 95% CI 0.46, 0.86), and more likely to be worried about discrimination if they contracted AIDS (aOR = 1.78, 95% CI 1.22, 2.61).</p> <p>Conclusion</p> <p>The uptake of VCT provided through either the facility or home based models is influenced by client characteristics such as proximity to service delivery points, HIV related symptoms, and fear of discrimination in rural Uganda. Interventions that seek to improve uptake of VCT should provide potential clients with both facility and home based VCT options within a given setting. The clients are then able to select a model for VCT that best fits their characteristics. This is likely to have positive implications for both service coverage and uptake by different sub-groups within particular communities.</p

Effect of anti-retroviral therapy on oxidative stress in hospitalized HIV-infected adults with and without TB.

BackgroundHIV infection and opportunistic infections cause oxidative stress (OS), which is associated with tissue damage. Anti-retroviral therapy (ART) is used to treat HIV and decrease the risk of opportunistic infections, but it is unclear whether ART reduces OS. Association of ART with OS was investigated.MethodsWe stratified a convenience sample of frozen serum or plasma from HIV-infected, ART-naïve (n=21); HIV-infected, ART-treated (n=14); HIV and PTB co-infected, ART-naïve (n=21); HIV and PTB co-infected, ART-treated (n=25) patients. Controls (n=21) were HIV-negative adults without TB symptoms. Concentration of OS markers namely: transaminases (ALT and AST), gamma glutamyl transpeptidase (GGT), albumin, total protein, malondialdehyde (MDA), vitamin C, and total anti-oxidant status (TAS) were determined.ResultsAST (p&lt;0.001), GGT (p&lt;0.001), total protein (p=0.001) and MDA (p&lt;0.001) were higher in HIV patients compared to controls. Vitamin C (P&lt;0.0001) and albumin (p&lt;0.01) were lower in HIV-patients relative to controls. ART was only associated with higher albumin (p=0.001), higher GGT (p=0.02) and lower vitamin C (p=0.009). HIV and PTB co-infection was only significantly associated with higher GGT (p=0.01) and AST (p=0.03).ConclusionWe identified severe OS among HIV-patients. ART was associated with both increased and reduced markers of OS hence suggesting that ART may not attenuate OS

Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis

Improving access to HIV testing is a key priority in scaling up HIV treatment and prevention services. Home-based voluntary counselling and testing (HBT) as an approach to delivering wide-scale HIV testing is explored here

In-hospital safety in field conditions of Nifurtimox Eflornithine Combination Therapy (NECT) for T. B. Gambiense Sleeping Sickness

Trypanosoma brucei (T.b.) gambiense Human African trypanosomiasis (HAT; sleeping sickness) is a fatal disease. Until 2009, available treatments for 2(nd) stage HAT were complicated to use, expensive (eflornithine monotherapy), or toxic, and insufficiently effective in certain areas (melarsoprol). Recently, nifurtimox-eflornithine combination therapy (NECT) demonstrated good safety and efficacy in a randomised controlled trial (RCT) and was added to the World Health Organisation (WHO) essential medicines list (EML). Documentation of its safety profile in field conditions will support its wider use

Practices and constraints of tomato production among smallholder farmers in Uganda

Tomato (Solanum esculentum) is one of the most promising vegetables whose production is being intensified in Uganda. However, tomato yields remain low due to several constraints. The study aimed at identifying production and marketing practices, and constraints affecting tomato productivity in major tomato growing areas of Uganda. A survey was conducted in eight major tomato producing districts using a questionnaire to guide interviews for 240 farmers and 16 key informants. The data were analyzed using SPSS software. Results revealed that tomato production in Uganda is dominated by males who grow them on 0.68 acres of land on average. Most tomato farmers (78.4%) use mono cropping system with varieties Asilla F1 (35.3%), Tengeru97 (21.1%), Rambo (18.1%), Novela F1 (17.7%) and Riogrande (10.3%) dominating. The choice of tomato varieties used by farmers mainly depend on yield potential, pest and disease tolerance and market preference attributes such as long shelf life. In the study area, tomato is mainly fertilized using foliar fertilizers, followed by Diammonium phosphate and cattle manure. The key pests affecting tomato include caterpillars, thrips, worms and whitefly, while bacterial wilt, blight, leaf spots and viral infections are the major diseases. Majority (95.7%) of farmers use chemical sprays (pesticides and fungicides) and 4.3% of farmers used other control methods. The other methods of pest and disease control included rogueing, hand picking, ash, organic extracts, urine and frequent weeding. Average tomato yield was 4,846.3 kg/acre lower than the potential yield of 6000kg/acre. Thirty five percent of farmers market their tomato individually on-farm, 32.8% sell in rural markets, while 32.2% send to the nearest urban markets. The study revealed intensive chemical use accounting for 20% of the production costs, high seed costs (11%) and drought (10%) as the major production constraints impeding tomato production; and price fluctuations, low prices, high transport costs, post-harvest loss on farm, and poor market access as the major marketing constraints. The research findings will aid in the development of new market-oriented, highly productive tomato varieties with improved access to seed and designing initiatives to address production and marketing constraints, which will eventually enhance tomato production

MicroRNA-122 and cytokeratin-18 have potential as a biomarkers of drug-induced liver injury in European and African patients on treatment for mycobacterial infection

Funding: Sarah Rupprechter was funded by the UK Medical Research Council via the Doctoral Training Programme Grant in Precision Medicine at the University of Edinburgh.Aims Patients on antituberculosis (anti‐TB) therapy are at risk of drug‐induced liver injury (DILI). MicroRNA‐122 (miR‐122) and cytokeratin‐18 (K18) are DILI biomarkers. To explore their utility in this global context, circulating miR‐122 and K18 were measured in UK and Ugandan populations on anti‐TB therapy for mycobacterial infection. Methods Healthy subjects and patients receiving anti‐TB therapy were recruited at the Royal Infirmary of Edinburgh, UK (ALISTER—ClinicalTrials.gov Identifier: NCT03211208). African patients with human immunodeficiency virus–TB coinfection were recruited at the Infectious Diseases Institute, Kampala, Uganda (SAEFRIF—NCT03982277). Serial blood samples, demographic and clinical data were collected. In ALISTER samples, MiR‐122 was quantified using polymerase chain reaction. In ALISTER and SAEFRIF samples, K18 was quantified by enzyme‐linked immunosorbent assay. Results The study had 235 participants (healthy volunteers [n = 28]; ALISTER: active TB [n = 30], latent TB [n = 88], nontuberculous mycobacterial infection [n = 25]; SAEFRIF: human immunodeficiency virus‐TB coinfection [n = 64]). In the absence of DILI, there was no difference in miR‐122 and K18 across the groups. Both miR‐122 and K18 correlated with alanine transaminase (ALT) activity (miR‐122: R = .52, 95%CI = 0.42–0.61, P 50 U/L with higher sensitivity/specificity than K18. There were 2 DILI cases: baseline ALT, 18 and 28 IU/L, peak ALT 431 and 194 IU/L; baseline K18, 58 and 219 U/L, peak K18 1247 and 3490 U/L; baseline miR‐122 4 and 17 fM, peak miR‐122 60 and 336 fM, respectively. Conclusion In patients treated with anti‐TB therapy, miR‐122 and K18 correlated with ALT and increased with DILI. Further work should determine their diagnostic and prognostic utility in this global context‐of‐use.Publisher PDFPeer reviewe

Structure-based design and synthesis of antiparasitic pyrrolopyrimidines targeting pteridine reductase 1

The treatment of Human African Trypanosomiasis remains a major unmet health need in sub-Saharan Africa. Approaches involving new molecular targets are important and pteridine reductase 1 (PTR1), an enzyme that reduces dihydrobiopterin in Trypanosoma spp. has been identified as a candidate target and it has been shown previously that substituted pyrrolo[2,3-d]pyrimidines are inhibitors of PTR1 from T. brucei (J. Med. Chem. 2010, 53, 221-229). In this study, 61 new pyrrolo[2,3-d]pyrimidines have been prepared, designed with input from new crystal structures of 23 of these compounds complexed with PTR1, and evaluated in screens for enzyme inhibitory activity against PTR1 and in vitro antitrypanosomal activity. 8 compounds were sufficiently active in both screens to take forward to in vivo evaluation. Thus although evidence for trypanocidal activity in a stage I disease model in mice was obtained, the compounds were too toxic to mice for further development