FACTORS INFLUENCING FOOD FORTIFICATION AS A MEANS TO COMBAT MALNUTRITION AMONG CHILDREN ATTENDING IMMUNIZATION AT NAKASONGOLA HEALTH CENTER IV. A CROSS-SECTIONAL STUDY.

Introduction:  Objectives: To determine the factors influencing food fortification as a means to combat malnutrition among children attending immunization whereas the specific objectives were to assess the knowledge of caretakers, ascertain the attitude, and determine the practices affecting food fortification as a means to combat malnutrition among children attending immunization at Nakasongola Health center IV. Methods:  A cross-sectional study was conducted in the district at Nakasongola Health Center IV. Simple random sampling was used to recruit 100 respondents who had brought children for immunization and data was analyzed using Excel. Results: The results from this study revealed that more than 50% of the participants were not aware of the term ‘food fortification’. Most of the participants (86%) were not aware of the fact that the Ugandan government made food fortification compulsory on staple foods and the majority of the respondents reported their source of information as health personnel 63(63.0%). Over 60% of the caretakers reported that they cooked fortified foods in the same way as unfortified foods while 33% cooked the fortified food differently. Most participants (90%) of the respondents think food fortification is important, 22% of the respondents read food labels before buying food while only 2% of the respondents feed their children on fortified food. Conclusion:  Overall, the study suggests that while there is some level of awareness and positive attitude towards food fortification among caretakers of children attending immunization at Nakasongola Health Center IV, there is still a need for further education and promotion of food fortification practices. This can be achieved through increased awareness campaigns and education by health workers and other stakeholders. Recommendation: Education and awareness campaigns should be conducted to increase knowledge about food fortification, its benefits, and the use of fortified foods among the population. 

High Levels of Persistent Problem Drinking in Women at High Risk for HIV in Kampala, Uganda: A Prospective Cohort Study.

The aim of this study was to describe the epidemiology of problem drinking in a cohort of women at high-risk of HIV in Kampala, Uganda. Overall, 1027 women at high risk of HIV infection were followed from 2008 to 2013. The CAGE and AUDIT questionnaires were used to identify problem drinkers in the cohort. Interviewer-administered questionnaires were used to ascertain socio-demographic and behavioural factors. Blood and genital samples were tested for HIV and other sexually transmitted infections. At enrollment, most women (71%) reported using alcohol at least weekly and about a third reported having drunk alcohol daily for at least 2 weeks during the past 3 months. Over half (56%) were problem drinkers by CAGE at enrollment, and this was independently associated with vulnerability (being divorced/separated/widowed, less education, recruiting clients at bars/clubs, and forced sex at first sexual experience). Factors associated with problem drinking during follow-up included younger age, meeting clients in bars/clubs, number of clients, using drugs and HSV-2 infection. HIV prevalence was associated with drinking at enrollment, but not during follow-up. This longitudinal study found high levels of persistent problem drinking. Further research is needed to adapt and implement alcohol-focused interventions in vulnerable key populations in sub-Saharan Africa

Response to Cummins and Finaret (2019)

We thank Joseph Cummins and Amelia Finaret for their interest in our article (Comandini et al., 2019) and their insightful comments, which allowed us to further discuss the issue of age imprecision in nutritional studies. In this response, we aim to stress some points that interfere with the analysis of the three major concerns highlighted by the authors

Association between Mycoplasma genitalium infection and HIV acquisition among female sex workers in Uganda: evidence from a nested case-control study.

OBJECTIVES: Cross-sectional studies have shown a strong association between Mycoplasma genitalium and HIV infections. We previously reported that in a cohort of female sex workers in Uganda, M genitalium infection at baseline was associated with HIV seroconversion. Here we examine the temporal association between the M genitalium infection status shortly before HIV seroconversion and HIV acquisition. METHODS: A nested case-control study was conducted within a cohort of women at high risk for HIV in Kampala. Cases were those of women acquiring HIV within 2 years of enrolment. For each of the 42 cases, 3 controls were selected from women HIV negative at the visit when the corresponding case first tested HIV seropositive. The association between HIV acquisition and M genitalium infection immediately prior to HIV testing was analysed using conditional logistic regression. RESULTS: There was weak evidence of an association between M genitalium infection and HIV acquisition overall (crude OR=1.57; 95% CI 0.67 to 3.72, aOR=2.28: 95% CI 0.81 to 6.47). However, time of M genitalium testing affected the association (p value for effect-modification=0.004). For 29 case-control sets with endocervical samples tested 3 months prior to the first HIV-positive result, M genitalium infection increased the risk of HIV acquisition (crude OR=3.09; 95% CI 1.06 to 9.05, aOR=7.19; 95% CI 1.68 to 30.77), whereas there was little evidence of an association among the 13 case-control sets with samples tested at an earlier visit (crude OR=0.30: 95% CI 0.04 to 2.51; aOR=0.34; 95% CI 0.02 to 5.94). CONCLUSIONS: Our study showed evidence of a temporal relationship between M genitalium infection and HIV acquisition that suggests that M genitalium infection may be a co-factor in the acquisition of HIV infection

Bacterial vaginosis among women at high risk for HIV in Uganda: high rate of recurrent diagnosis despite treatment.

OBJECTIVES: Bacterial vaginosis (BV) is associated with increased risk for sexually transmitted infections (STIs) and HIV acquisition. This study describes the epidemiology of BV in a cohort of women at high risk for STI/HIV in Uganda over 2 years of follow-up between 2008-2011. METHODS: 1027 sex workers or bar workers were enrolled and asked to attend 3-monthly follow-up visits. Factors associated with prevalent BV were analysed using multivariate random-effects logistic regression. The effect of treatment on subsequent episodes of BV was evaluated with survival analysis. RESULTS: Prevalences of BV and HIV at enrolment were 56% (573/1027) and 37% (382/1027), respectively. Overall, 905 (88%) women tested positive for BV at least once in the study, over a median of four visits. Younger age, a higher number of previous sexual partners and current alcohol use were independently associated with prevalent BV. BV was associated with STIs, including HIV. Hormonal contraception and condom use were protective against BV. Among 853 treated BV cases, 72% tested positive again within 3 months. There was no difference in time to subsequent BV diagnosis between treated and untreated women. CONCLUSIONS: BV was highly prevalent and persistent in this cohort despite treatment. More effective treatment strategies are urgently needed

Instituting Sustainable Geriatric Care in Africa: The Roles of Sociocultural Constructs

The demographic shift in Africa is seeing more people make it to old age (60 years or over), a state associated with an increased risk of acquiring communicable and non-communicable diseases, and demand for specialised health care. With many African health systems still struggling with infectious diseases, inadequate funding, poor infrastructure and lack of skilled human resource for health, how best can they provide quality, sustainable geriatric care services to their ageing population? This commentary highlights “Africa’s social-cultural structure” as an opportunity health policy makers could tap into, to design patient-centred, sustainable, inexpensive, and socially acceptable geriatric interventions

Condom use among female sex workers in Uganda.

Consistent condom use can prevent HIV infection, yet levels of condom use are low in many settings. This paper examines determinants of inconsistent condom use among 905 women enrolled in a high-risk cohort in Kampala, Uganda, who reported sexual intercourse with paying clients in the last month. Among these, 40% participants reported using condoms inconsistently with paying clients in the past month. The most common reason for inconsistent condom use was client preference. Factors independently associated with inconsistent condom use included: sex work not being the sole source of income [adjusted odds ratio (aOR) = 1.54; 95% confidence interval (CI): 1.13-2.09], sexual debut before 14 years (aOR = 1.46; 95% CI: 1.09-1.96), daily consumption of alcohol (aOR = 1.90; 95% CI: 1.26-2.88) and being currently pregnant (aOR = 2.11; 95% CI: 1.25-3.57). Being currently married (aOR = 0.36; 95% CI: 0.18-0.73) and a higher number of sexual partners per month (p-trend = 0.001) were associated with a lower risk of inconsistent condom use. Targeted programmes should be developed to promote consistent condom use in high-risk women, alongside interventions to reduce alcohol use